Outrageous

Minister for the Disabled Mike Penning has apologised

The UK Government has apologised for sending a letter to a woman in a coma pressing her to seek work - see the story here.

I don't doubt that this specific error (sending the letter when she was in a coma) was a rare or even one-off mistake but the full story reveals a much more common problem, namely the hounding of people with a serious mental illness to the point where they become ill.

The family of Sheila Holt reports credibly the sequence of events after she was required to attend a job-seeking course during which she became progressively more agitated and distressed (she has bipolar disorder) to the point where she had to be admitted to hospital. She subsequently had a heart attack which caused the coma...and then the nightmare continued as she got the next letter.

She had to attend the wretched course because otherwise her means of survival - her benefits - would have been taken from her.

Her father says "If they had left her alone she would not be in this condition. They were threatening her with cuts and she needs the benefits. I just believe it's all wrong, you should be chasing the people who are fit, get them to work, not them that are not fit. It's outrageous."

Yes, outrageous - and thoughtless and cruel. There is no economic case for harassing people with a serious mental illness towards employment, even if it was not unforgivably unjust as in Sheila Holt's case. Anybody can see that it is counterproductive to pressurise people who are vulnerable - and in this poor woman's case the result is huge financial cost in addition to the terrible personal price she has had to pay.

Many people with a serious mental illness can get back to work and it should indeed be a personal goal for all but a few of those who are of working age - but it has to be on the basis of them determining when and if they are ready.

Social Media Junkie

There has never been a better or more important time to join Hafal! Join our growing membership by following this link and never be alone again with serious mental illness.

And if you are a social media junkie - or just use social media I should say - then go and "like" or "follow" us on Facebook and Twitter. Actually you can look at our stuff on these platforms without being signed up to them yourself, something which isn't always understood.

I read somewhere that some people are uncomfortable clicking a button that says "like" or "follow" because this obviously implies some kind of affection, respect or support.

But I'm afraid it is all there is for now until they invent an "I want to keep a grudging, cynical and detached eye on you" button.

Salient Point

My grandfather's battalion - 3 Durham Light Infantry - on the way to the front - note the shell bursting in the background

I am enjoying reading 1913 The Year Before The Great War. This is a clever book because it deliberately resists hindsight and describes a time when people did not actually expect a war, still less a cataclysmic one.

Because of the centenary we are hearing a lot about the First World War (now there's a hindsight-based term which only makes sense after 1945!) and it is right that today there is debate about causes and responsibility.

But I am surprised how little acknowledgement there is about how raw and present the Great War (better term) is today.

I think this is because people are most focused on those who died in that war - quite rightly - but they forget that most of the combatants survived and were vigorous, influential people right up to fairly recent times.

In my case I was very much influenced as I grew up by my grandfather Arthur Floyd to whom I and my brothers were very close. He never much spoke about his war but had fought right through from 1915 until the end, returning in 1919, and beyond doubt his whole take on life must have been shaped by his experience as a young man who volunteered and played his part.

I remember my grandfather affectionately as someone who had a thin veneer of old-fashioned and conservative values but in reality was a playful and thoughtful person who made up his own mind.

Recently my Mum lent me a box of about 300 letters which he wrote during the war to his fiancée (later his wife and my granny). I have only so far dipped into these but was astonished and much uplifted to find how he was very far from being an unthinking cog in the British army's massive deployment of men.

I shouldn't be surprised but don't we all have a rather monochrome and undifferentiated impression of what it must have been like?

Among other revelations the letters show Grandpa...

• Joking that he rather approved his men wanting to shoot a snooty colonel during a near mutiny.

• Discussing with fellow officers the pointlessness of their expensive swords (which they had to pay for) - they tried to spear fish in a pond with them and agreed that was the only thing they might be useful for.

• Trying to resign his commission with some of his friends because his mess fees were more than his pay (a problem sorted I believe by Lloyd George - the army hadn't worked out what to do about able volunteer officers without private means).

• Arranging a memorial cross (there is a sketch in his letter - and a photo shows it was accurate - I didn't know anybody did this in the midst of the war?) for his fiancee's brother my great uncle Howard - killed in 1916 - Grandpa knew him very well as an older friend. Howard refused a commission out of principle to serve alongside his co-workers in Tyneside and became a respected sergeant.

And yet the same letter goes on to joke and talk about helping families back in Gateshead.

The public record shows appalling suffering by my grandfather's battalion - including releasing gas against the Germans (bringing canisters up the line, letting them off, and then horrible results as the Germans retaliated). Naturally he didn't talk about these things in the letters.

The record also describes a court martial where my grandfather sat in judgement on a soldier who accidentally killed a comrade having failed to remove bullets from his rifle as he returned from the line. I'm pleased to report that Grandpa let him off on the grounds that the poor man was utterly fatigued and could be forgiven for not following procedure.

The record shows that the battalion suffered average casualties, mainly experienced when they were twice nearly overwhelmed by German counter-attacks. The battalion is given credit for holding the line - probably including when my grandfather got his "mention in dispatches".

In the letters there are also lots of reported conversations with French people (quoted in French because unusually he and my grandmother knew French) and, above all, many reports of him playing piano to cheer his men when back from the front! He was an accomplished player with two posh grand pianos in his drawing room. As he played them in later life he must have thought about the times when he played a crummy upright to accompany his men singing.

When life seems oppressive it is sobering to compare it with the life of a 23 year-old lad struggling for months on end to lead his men and survive, surrounded on three sides in the Ypres Salient.

Drills And Hammers

Get used to seeing the new hazard symbols on the right

An interesting experience this week when I attended Hafal's one-day Health and Safety training course - compulsory for all staff so no wriggling out of this one. But it was actually very instructive and useful.

I was familiar with the information about our own policies and procedures - and so I should be obviously - but it was particularly valuable to hear staff talk about how they engage with health and safety day-to-day. I feel like we are doing reasonably well but it is a continuing journey and there is no end - it is just the nature of risk that there are always new ways to reduce it.

I was also interested to hear our H and S consultant Amanda Trimble talk about what she describes as her special obsession - asbestos.

Little wonder she is concerned about it. If I heard her right there are about 150 fatal accidents in work in the UK each year but about 8,000 deaths from work-related illnesses - and most of those are from asbestos.

If you don't know this already please don't bash about your house (or anybody else's) with drills and hammers etc (unless it was built after 1999) without establishing where the asbestos may be!


Postscript:

For a perspective on the UK's current rate of workplace fatalities consider the explosion in the Senghenydd Colliery on 14 October 1913 which killed 440 men and boys. The owner William Thomas Lewis, First Baron Merthyr, had failed to put a safety plan in place following an earlier disaster - and so was fined £10 (equivalent to fivepence halfpenny per death - about 2p in new money), not a lot even then.

The dead were in a way early casualties of the Great War which came the following year. The Royal Navy was desperate for Welsh steam coal to power their fleet in competition with Germany and the government saw mine safety as a distant second to productivity.

Hard-Nosed

All aboard for Hafal's and our partners' campaign on treatments

Fascinating exclusive interview with Consultant Pharmacist Professor Stephen Bazire by Mental Health Wales here.

The Professor, a valuable friend to Hafal, is a world leader in setting out accessibly the pluses and minuses of drugs for mental illness. He has a subscription website but there is a free version run by the National Centre for Mental Health which you can see here.

I think his remarks about the typical versus atypical antipsychotic debate are timely and incisive. It actually isn't that helpful to compare the two categories as a whole. In practice it is much better to look at each medicine separately and consider its efficacy, side effects, risks and management/monitoring requirements - all of which vary widely within each category.

Nevertheless, and I know the Prof wouldn't disagree, it remains vitally important to guard against use of poor, cheap, older drugs for reasons of cost and without the patient and their family knowing what else is available.

I think the NICE guidelines are penny-pinching - psychosis is too serious a condition to justify a "try something cheap first" approach. Prescribers should be able to choose the best drug for the patient from a range of both typicals and atypicals.

I recollect that in the US I saw expensive antipsychotics being prescribed to patients on Medicaid as the first option not because the system is generous but because the hard-nosed private insurers whom the government contracted for this work had worked out that it was cheaper in the long run because patients got better and cost less in terms of care and support!

Not sure I agree quite so much with the Professor about anti-depressants. He points to the positive effect on rates of suicide but I think it is likely that over-prescription, especially in Wales, is damaging lives on a very large scale. It is a subtle point because you can't easily measure the decrease in vigorous engagement in life which these drugs can cause. But you can see those effects in people who take antidepressants, even to the point where you can guess that somebody has started using them just through casual acquaintance. They should not be used lightly but, yes, they should be used to protect and assist some people with at least significant problems.

Anyway, the interview is vital reading so please follow the link above. And look out for the next edition of Mental Health Wales which has a focus on treatments, a preliminary for our campaign on treatments which will commence in October (when our campaign on physical health, due to start in May, is completed). No peace for the wicked.

Fish-Fingers And Shampoo

Merlin's Oak in 1936

"When Merlin's Oak shall tumble down,
Then shall fall Carmarthen Town."

I remember the famous Oak well but it was knocked down in an appalling act of vandalism in 1978 - by the council. Has the prophecy come true, albeit metaphorically?

I lived in Carmarthen for a couple of years in the mid 1980s but I rarely visit now even though it is nearby - but I did go this weekend and had a nose around while Mrs B tracked down fish-fingers and shampoo.

The old provisions market is gone and its much smaller replacement is a pale shadow; and in the place of the previous livestock market you can find Debenhams and some of the other usual suspects (I mean "outlets"). The one improvement is the modern cinema - I'm a big fan of these with their comfortable seating and choice of films.

But I struggle to see the point (for me at any rate) of these small market towns when there is nothing you can't find on a much larger scale in the big cities.

I'm not a fan of farmers' markets. Serious farmers haven't the time or inclination to retail their produce so you just get the variable quality but invariably expensive offerings of amateur small-holders.

If you want good meat go to a good butcher or to Tesco or one of the other supermarkets which have a range from cheap and satisfactory all the way to very superior with a quality "provenance" (just don't be fooled by the Red Tractor "quality mark").

I used occasionally to visit the bar of the Boar's Head - quite a hair-raising experience on market day and after hours in those days - but I never noticed this gem immediately opposite on Lammas Street...

English Baptist Church (architect George Morgan 1834-1915)

Moules Frites

Plucky little Belgium resists the Hun bully - exactly 100 years ago this 4 August

Belgium is a strange country but one for which I have a little affection based on a few visits. It is imaginative of them to discover the enormous merit in combining mussels with chips (and a big pot of mayonnaise of course) even if their fruit-flavoured beers are a clear mistake; it is curious that the country only exists on the whim of the winners of the Napoleonic wars (the Duke of Wellington in particular) and so not that surprising that the two distinct linguistic groups find it almost impossible to agree how to govern the country - and yet Belgium became arguably the most successful country in Europe when it didn't have a government - a lesson there surely; strange again that the only two Belgians anybody has heard of (Tintin and Hercule Poirot) are (a) erroneously but almost universally thought to be French and (b) fictional.

It is quite possible that Belgium's success is precisely a result of it having no cultural identity - with no axes to grind it can just pragmatically concentrate on enriching its citizens and generally having a good time, leaving it to individuals to decide what their cultural values are. Good luck to them.

But it saddens me that today the Belgian parliament is likely to extend the right to euthanasia to children (see the story here).

Exceptionally the law in the UK which forbids assisting people to commit suicide can cause distress - it is easy to point to a small number of cases where it is unfortunate that people cannot get help to die with dignity.

But exceptions make bad law. Euthanasia means that the state sees suicide as an accepted option - a very bad message especially to people with a serious mental illness, many of whom already take their own lives, a shocking, terrible tragedy not a lifestyle choice.

Further, legalising euthanasia brings other unintended consequences including pressure on people to stop bothering their family or services with their illness; and then there are all those ghouls who relish involvement in death (in contrast to the overwhelming majority of doctors who want nothing to do with euthanasia).

There is so much to applaud about Belgium's libertarianism but on this they have got it badly wrong.

NICE One

Useful advice from NICE about supporting carers of people with schizophrenia - see the story here. Actually this should of course apply to all carers of people with a serious mental illness.

The new guidance sets out key practice for mental health services to:-

• Offer carers of people with psychosis or schizophrenia an assessment (provided by mental health services) of their own needs and discuss with them their strengths and views. Develop a care plan to address any identified needs, give a copy to the carer and their GP and ensure it is reviewed annually.

• Advise carers about their statutory right to a formal carer's assessment provided by social care services and explain how to access this.

• Give carers written and verbal information in an accessible format about: diagnosis and management of psychosis and schizophrenia; positive outcomes and recovery; types of support for carers; role of teams and services; getting help in a crisis.

• When providing information, offer the carer support if necessary.

• As early as possible negotiate with service users and carers about how information about the service user will be shared. When discussing rights to confidentiality, emphasise the importance of sharing information about risks and the need for carers to understand the service user's perspective. Foster a collaborative approach that supports both service users and carers, and respects their individual needs and interdependence.

• Review regularly how information is shared, especially if there are communication and collaboration difficulties between the service user and carer.

• Include carers in decision-making if the service user agrees.

• Offer a carer-focused education and support programme, which may be part of a family intervention for psychosis and schizophrenia, as early as possible to all carers. The intervention should: be available as needed; have a positive message about recovery.

Pretty obvious stuff, most of it, but valuable in itemising some basics when carers are in practice often ignored.

I would also commend to carers that they remind themselves frequently about Hafal's Ten Point Plan - sound advice because created by fellow carers!

Scrooples

Lord Byron in Greek costume - I suspect that the locals just assumed that was how all English milords dressed - otherwise they would have thought him a complete wally?

Yesterday I decided to stay in because of the truly awful weather. But I regretted it and felt a bit tetchy and claustrophobic when the darkness closed in and it was too late. I think you need to get out even into a storm (and even if briefly) so that you can recharge. So this morning with a superhuman effort I wrap up and get out early.

This lets me think about what I did do yesterday which was to read a book which Mrs Blog had bought for herself "to read next winter" (remarkable forward planning?).

The book is Greece On My Wheels by Edward Enfield. Edward is the father of comedian Harry Enfield and (you may recall) he had a second career on the back of his son's fame (so he says) as a contributor on telly triviality Watchdog about 10 years ago; he has also written for the Oldie magazine - mostly coy and knowing stuff which I didn't like.

The book describes a cycling trip around western Greece - the Peloponnese and northwards up to Albania - on the trail of Lord Byron and other heroes of the Greek War of Independence. I expected little of the book but actually it is good, partly because Enfield did the trip aged 69 but never bangs on about the physical challenge for somebody his age; also because he conveys his enthusiasm as a classicist and philhellene (like Byron and so many of his contemporaries) as he pokes around the ruins of taverns and monasteries which the poet dossed down in before finally dying from fever and becoming Greece's most famous and celebrated adopted son.

As a classicist and I suppose a bit of a philhellene (but I also have a contradictory soft spot for the Ottoman Empire) I nevertheless find Byron himself hard work.

Yes, the world is a more colourful place today because he lived. It is even arguable that Greece is free because of him: his military exploits were inconclusive and cut short but his influence on the (classically-educated) British political establishment was immense and these men eventually stepped in to force the Ottomans to concede to the Greeks in a war that had become a stalemate.

But Byron was a self-centred and self-regarding personality without any ability to stop and think - and this influenced his poetry, his personal relationships, and of course his mission to Greece, making all those things magnificent and exciting but ultimately chaotic and flawed.

And no Welsh connection for once, I hear you say?

Ah, but there is. One of Byron's closest friends - and the person who bankrolled his early exploits and set him on his course to fame - was Scrope Davies, son of a clergyman from Caio in Carmarthenshire. Scrope was a gambler of modest means who one night, having been left by his worried friends apparently losing badly at cards, emerged the next morning with £20,000 stuffed into a chamber pot. This event - the vast fortune yielded through Davies' nerve and the turn of a few cards - indirectly made Byron what he became.

Inevitably Davies' luck didn't hold and some years later he ran away to France to escape his debts. There is no portrait of him but his papers turned up in a bank in the 1970s. From these we learnt that he was not just a lucky dilettante but a professional gambler who kept careful records of card games and their effect on his finances. He didn't marry and had no children - Byron teased him about that telling him he should have had some little "Scrooples".

Byron dead at Missolonghi - a sanitised view of a squalid death although a brave one - he discussed the propaganda value of his death as he sank away. Note the allusions - lyre for a poet, sword for a warrior, statue to ἐλευθερία (liberty) for the idealist, and a laurel wreath for victory (premature but ultimately true)...

Where There's A Will...

Irrelevant picture to lure you into a rather dusty subject

We have just refreshed our advice about giving to Hafal - just about legible in the image below but if you want to be kinder to your eyesight please follow this link.

I attended a workshop a few months ago about how to get people to leave money to charity in their will. Among all the advice I was particularly interested to learn that a lot of people don't like the charity to know about their intention to leave them money - and may even strike you out if you go back and enquire, however courteously, after somebody has (for example) asked you for a leaflet on legacies.

Apparently this infuriates professional fundraisers because they want to be able to chalk up success in advance of what may take many years to yield a result!

So I will stop there and allow you to potter down to your solicitor and leave a handsome bequest to Hafal. And I promise not to press you for details - it will just be a nice surprise when we get it, hopefully in many, many years time of course.

Bronze Meddle

Hafal has produced a policy briefing for Assembly Members to consider as they debate the Social Services and Well-being (Wales) Bill today. The briefing highlights a number of improvements that need to be made to the Bill which was introduced by Gwenda Thomas, Deputy Minister for Social Services last January and will come into force in 2016...

Hafal welcomes the principles and intentions set out in the Social Services and Well-being Bill, and in particular the intention to improve access to and the provision of social services across Wales, as well as increasing the consistency of services and giving people a stronger voice and greater control over the services they receive. We are also pleased that the Bill for the first time puts carers on an equal legal footing with those they care for as well as consolidating and strengthening much of the existing legislation relating to carers.

We fully support the policy briefing developed by Carers Wales and endorsed by the Carers Alliance which calls for the provisions set out in the Carers Measure and its subsequent regulations to be transferred into the new Bill. The Carers Measure has been widely acknowledged as a flagship piece of Welsh legislation and is working well. Importantly, the Carers Strategies (Wales) Regulations 2011 placed duties on Local Health Boards, local authorities and NHS Trusts to provide appropriate advice and information, and made Local Health Boards the lead authority for developing a strategy to set this out. This duty looks like it may be lost under the proposed Bill. Carers Wales has pointed out that most carers have contact primarily with health services, and we think it is therefore crucial that the duties placed on Health Boards as set out in the Carers Measure and its regulations are fully included within the new legislation.

See the full text via this link.

We also plug away in our briefing on the need for integration of health and social care.

Perhaps one day instead of separate health and social care legislation we will see a combined Bill which addresses these things together? Meanwhile I confess that I am disappointed if not really surprised that Sir Paul Williams' report took the "easy" option of reducing the number of Councils instead of radical change including single health and social care organisations.

He says all the right things about the need to cooperate but that has been said before, hasn't it?


Postscript:

Hafal Chair Elin Jones confirms to me that she buys into the "we were here all the time" line - see my last post. All the more shame on us for not having yet worked out how many Councils we need if we have been meddling with the problem all the way back to the Bronze Age.

Pembrokeshire residents discussing possible merger with Ceredigion:-

Any Old Iron Age?

Longstanding Welsh-speakers built this - without the 30% Latin of course...

I've been listening to the radio...

In the anglo-centric history of these isles it is conventional to accept that the "Celts" (nobody knows what that means) moved from central Europe in the late Iron Age and inhabited Britain at some time before the Romans turned up. I learnt this vaguely in childhood although I confess I gave up history (like I did geography) aged 12 in order to learn Greek (see my last post - Greek is hard).

But actually there is precisely zero evidence for this. It probably stems from the (anglo-centric) assumption that waves of civilisation came in periodically from the east. But actually there is no reason to think that there was an earlier version of Anglo-Saxon invasion by our Celtic ancestors.

On the contrary evidence is now coming in that I was oddly right to concentrate on Greeks in understanding the origin of the Welsh and their language.

Greek historian Herodotus (see my take on him here) referred to a Celtic community in southern Spain at Tartessos which Radio 4's "Making History" (link here) this week suggests may offer evidence that in fact - we were here all the time!

Careful, now, we sort of knew about this evidence, but what makes me think it is significant is that the pre-eminent Celtic historian of our time (and no Welshman) Barry Cunliffe agrees that this is convincing.

If this were about the English people it would be huge news - people care a lot about where they came from - but this bit of history is buried in the depths of the BBC's website.

So the new evidence suggests that we were here all along - back into the Bronze Age - developing our language and trade along the western seaboard of Europe. But actually it makes sense because it is consistent with - much later - communication and trade into the Dark Ages.

I was taught by eminent scholars (in my fields of Greek, Latin, and ancient philosophy) that the obvious explanation is the most likely one. Doesn't that apply in history too? I will report back on whether serious historian Hafal Chair Elin Jones will back this up...

Greek

The Towy this morning - you can't actually see its normal banks

I got absolutely soaked yesterday walking west up the Towy Valley but it was better today walking east, though I needed my wellies to trudge on the valley floor much of which is still under water. You can see how the river changes its course over the years as it finds a quicker route and digs away at the banks during the floods. Presumably the familiar pattern of meandering and stranded oxbow lakes is caused as much by flooding as by routine erosion - I can't remember as I gave up geography aged 12 (it was that or Greek).

While I am walking I hear on the news that it has been the wettest January since 1767 - clearly they say an indication of global warming (sorry I mean "climate change" - since it got colder they have moved the goal posts and kept their options open).

On that logic there must have been a lot of greenhouse gas around in the mid-late 18c. That would have been all the smoke and soot coming out of those up-and-down pumping steam engines - they didn't invent steam engines which could actually turn a wheel until the 1780s.

For the record I am not myself a "climate change denier" (a cleverly coined, pejorative label sounding a bit like "holocaust denier") but a neutral observer with no knowledge of these things - it's all Greek to me (as it were).

What I observe is that there are vested interests of big business on the one side and shouty environmentalists (and, increasingly, other big business) on the other, debating about what remains circumstantial evidence (nothing wrong with circumstantial evidence but it tends to leave things somewhat unresolved); I also observe that "respectable" institutions have been caught out telling porkies or making false claims about the science. Humankind probably is affecting the climate but it is very hard to tell how much, whether for net better or worse, and whether it is worth trying to do anything about it.

But step forward the Prince of Wales to arbitrate this difficult matter. This week he addressed a conference of "sustainability entrepreneurs" (story here) where he called the sceptics "headless chickens". An odd choice of words as the expression is usually used about the people who are panicking. Right or wrong the sceptics are surely saying that we should not panic. Still, you get where he stands on this.

But then the Prince of Wales also campaigns vigorously for precious NHS resources to be expended on homoeopathy instead of (for example) mental health. Now that is one debate where the science is completely clear. There is no more evidence for the effectiveness of homoeopathy than there is for witchcraft or tarot cards.

Listening to my tiny mp3/radio while out walking - multitasking in action