Sweet Caroline

Clever advertising steering around bad law

So it is the 50th anniversary of the birth of Radio Caroline. That will make the baby boomers feel old. Not me, I'm too young to be a boomer so I got only half of those legendary late 20th century benefits (e.g. free university tuition fees) but will not get the other half (e.g. retirement pension at 65).

But I was by chance listening to the final broadcast from Caroline in 1980 as she sank in the North Sea, a memorable moment in radio history as the crew broadcast until the water lapped at their feet and they had to get out sharpish carrying their canary Wilson (named satirically after the former Prime Minister who had tried to close them down).

Caroline is mainly remembered for forcing the Beeb to start broadcasting contemporary music which was indeed a momentous cultural revolution. But pirate radio should also be celebrated as the vanguard of independent, unfettered broadcasting which has almost been realised today, no thanks to government but because the internet makes it impossible to control the media, essentially a good thing though obviously, with complete freedom to broadcast, there will be wicked people doing it too.

Tony Benn didn't quite live long enough to see the Caroline anniversary but presumably he would not have celebrated since he was the minister in the 1960s who instigated the criminalisation of off-shore broadcasting, an act which killed off most of the pirates - but not Caroline which held on precariously in a legal limbo. In spite of his cuddly image in modern times Benn actually belonged to that bossy generation of politicians (of the right as well as the left) who didn't trust citizens with anything much and felt the need to control the flow of information at every point.

These things matter because restriction of information ends up hurting vulnerable people, not least people with a mental illness, who are safer if those who might mistreat them cannot easily hide. However, the protection which free media afford is at risk if the government (and other political parties in alliance with those sleazy, embittered celebs and millionaires caught with their trousers down) succeed in their current disgraceful attempt to curtail press freedom.

Reciprocation

This year's Let's Get Physical! campaign will be launched at the Pierhead, Cardiff Bay, by Minister for Health and Social Services Mark Drakeford AM on 8th May 2014. The event is sponsored by Lindsay Whittle AM. More information will follow.

The campaign will involve lots of practical action by people with a serious mental illness and their families to promote their physical health - and I'll feature this in the Blog in the coming weeks.

But we also challenge GPs, other health and social care professionals, Health Boards, local authorities and the Welsh Government to reciprocate by ensuring that:

● all aspects of physical health are systematically addressed as part of clients’ Care and Treatment Plans including actions to address diet and physical activity

● the Care and Treatment Plan specifically and routinely takes into account the management of the side-effects of medication: for example, if the medication is causing weight gain, the "physical health" section of the Plan is the place to set out ways of dealing with this

● service users receive regular health checks from their GP – and all identified issues are addressed fully; these checks should include all that is available to the general population and additional interventions linked to their specific risk factors (as antipsychotic medication may increase the risk of heart disease, obesity, diabetes, etc.)

● a double-booking system is routine so that service users have longer appointments to fully address their physical health needs

● people with a serious mental illness are offered a range of physical activities as part of a treatment approach, including use of gym equipment, swimming, walking, etc.

● the opportunity for physical exercise using gym equipment, walking, etc., is routinely offered to all in-patients as well as those being treated in the community

● doctors and psychiatrists provide accessible, comprehensive information (preferably in hard copy form) on the choice of medications including advice on dosage, side-effects, management issues and efficacy so that patients can make an informed choice based on their own values

● staff in primary care (including administrative staff) are made aware of a patient’s mental illness at their request and make appropriate allowances for their specific needs

● inequalities in health and social care outcomes for people with a serious mental illness are decisively reduced

● local authorities and Health Boards work in a fully integrated way to address the physical health care needs of people with a serious mental illness

● the physical health care needs of carers are properly assessed and addressed

● carers are offered regular health checks

● GPs keep a record of whether someone is a carer so that they are aware of the added pressure this may put on their physical health

● Carers’ Assessments routinely take into account the physical health needs of carers

● carers are provided with advice and information on engaging with leisure facilities in the community

● carers are provided with practical support and respite opportunities so that they have the time to take part in physical exercise and shop for the best value food

On The Road 2 - Over There

I spotted an interesting initiative by our good friends in the USA - NAMI (the National Alliance on Mental Illness) - follow this link.

NAMI Walks involves thousands of supporters taking a walk together in dozens of locations across the States. This is a nice link to our Let's Get Physical! campaign which we will be launching in May so I must suggest to our extensive social media team that we link up and compare notes...

NAMI is US's largest grassroots mental health organisation dedicated to building better lives for the millions of Americans affected by mental illness. They advocate for access to services, treatment, support and research and they are steadfast in their commitment to raise awareness and build a community for hope for all of those in need.

They are also the foundation for hundreds of NAMI State Organisations, NAMI Affiliates and volunteer leaders who work in local communities across the country to raise awareness and provide essential and free education, advocacy and support group programmes.

Wales is almost exactly 100 times smaller in population than the United States and Hafal is about 100 times smaller than NAMI - but they are good friends and we have a great history of exchanges and mutual support.

It Has To Be Tea

I see it as one of my self-appointed tasks during our summer campaign to try to rehearse some diet and exercise tips from my own limited experience. So here's an early go at that...

It's time to rehabilitate kippers and not necessarily for breakfast. Enjoy a kipper with brown bread and butter (thinly spread if you are keeping an eye on your weight) for tea.

The main objection to kippers is the smell which doesn't worry me but it is anyway easily avoided.

Best bet is to cook them in a jug. Put one kipper (minus head and tail) folded loosely into a tall jug and pour boiling water to cover it. You can do more kippers if you have a big jug but you can't pack them in - they've got to be very loose and you would need a lot of boiling water so careful as you go! Wait a minimum of 5 minutes then pour off the water, extract and eat. If you don't like the smell after it is cooked then eat it outside. If you don't like the smell even while you are eating it then try something else...

£5 per kilo today in Tesco for whole Scottish undyed kippers. And don't knock the little boil-in-the-bag or microwaveable fillets - follow the instructions and they are nice for breakfast and quite cheap.

If you try a kipper for lunch or later it's not really worth looking for a nice little Sauvignon Blanc to go with it. It has to be a cup of tea.

On The Road Again!

Details will follow but mark your diary with this year's campaign dates...

Let’s Get Physical! launch, Cardiff 8 May 2014
Bridgend, 16th May 2014
Rhondda Cynon Taf, 23rd May 2014
Merthyr Tydfil, 30th May 2014
Caerphilly, 6th June 2014
Newport, 13th June 2014
Blaenau Gwent, 20th June 2014
Torfaen, 24th June 2014
Monmouthshire, 4th July 2014
Swansea (Hafal’s Annual Physical Health Awareness Day), 10th July 2014
Vale of Glamorgan, 15th July 2014
Powys (at Royal Welsh Show – 21st to 24th July), 23rd July 2014
Wrexham, 1st August 2014
Denbighshire, 8th August 2014
Flintshire 15th August 2014
Conwy (Hafal North Wales Event), 22nd August 2014
Ynys Môn, 29 August 2014
Gwynedd, 5th September 2014
Ceredigion, 12th September 2014
Carmarthenshire, 16th September 2014
Pembrokeshire, 26th September 2014
Neath Port Talbot, 3rd October 2014
Cardiff  (World Mental Health Day event), 10th October 2014
Hafal Conference/AGM (celebration of Let’s Get Physical!), 6th November 2014

Disarmingly Humble

The Royal College of Psychiatrists has published a new Code of Ethics founded on 12 key principles which are worth rehearsing in full here...

The Code states that psychiatrists shall:-

(1) respect the essential humanity and dignity of every patient

(2) not exploit patients’ vulnerability

(3) provide the best attainable psychiatric care for their patients

(4) maintain the confidentiality of patients and their families

(5) seek valid consent from their patients before undertaking any procedure or treatment

(6) ensure patients and their carers can make the best available choice about treatment

(7) not misuse their professional knowledge and skills, whether for personal gain or to cause harm to others

(8) comply with ethical principles embodied in national and international guidelines governing research

(9) continue to develop, maintain and share their professional knowledge and skills with medical colleagues, trainees and students, as well as with other relevant health professionals and patients and their families

(10) have a duty to attend to the mental health and well-being of their colleagues, including trainees and students

(11) maintain the integrity of the medical profession

(12) work to improve mental health services and promote community awareness of mental illness and its treatment and prevention, and reduce the effects of stigma and discrimination

I invite patients and families to consider the psychiatrists with whom they have worked and test their actions against the Code. Many, I suspect, would agree that their psychiatrist does generally live up to the Code although I know anecdotally that there are some who feel badly let down.

Of course psychiatrists can live up to the Code but still fail to assist effectively, mainly for three reasons:

(i) Lack of resources - the Code obviously cannot guarantee that even the most essential services are available: that's beyond the control of individual psychiatrists and even the profession as a whole though obviously they have a significant degree of influence on those who determine resources (and they do their best to exert that influence, in fairness).

(ii) Lack of diagnostic certainty - quite simply our limited knowledge of mental illness makes even basic diagnosis, however carefully undertaken, hit and miss.

(iii) Lack of effective treatments - neither medical nor psychological treatments for serious mental illness are decisively effective and are often hardly effective at all. Antipsychotic medications can be effective at reducing some symptoms some of the time but with a heavy price in unwanted side-effects and limited understanding about how they even work; antidepressants remain crude and undiscriminating; the evidence base for talking therapies is poor, mainly confined to some limited, short-term effects on overt symptoms (like me you may believe that more in-depth therapies could be decisive - but the research just hasn't been done).

Nothing wrong with the Code of Ethics and I generally support the psychiatrists but, like others in the medical profession except perhaps more so, they need to be honest about the limitations of what they can do to help.

I know some individual psychiatrists who are disarmingly humble about the limited resources and the scant progress made in understanding and treating mental illness - and frankly they are the ones I would trust above all and I think they have the best relationships with their patients and with patients' families.

There is no point having high expectations about psychiatry today, every point in investing in research for the future.

Cannery Row

Welsh language version of our Let's Get Physical! campaign logo

Since my back trouble last year I have been wary about swimming outside even if the water is heated as it is at my gym. I was afraid I might seize up in the cold air or in the not so warm water.

But this morning it was impossible to resist swimming a few lengths outside at 7.30 a.m. as the sun came up - and no adverse affects so far.

While I swam I contemplated my chances of making some progress in increasing my own physical fitness this spring and on into the summer, inspired by our Let's Get Physical! campaign.

The campaign is aimed at (and indeed run by) clients and carers primarily but of course we hope staff will also join in and benefit. We are working with Bipolar UK and the Mental Health Foundation with extra support from Diverse Cymru to make sure we reach out to everybody. More will follow soon on this.

Anyway, back to me. I'm not very fit at present and carrying a bit more weight, mainly as a result of my illness last year which set back my exercise routines. So, how to get moving again on diet and exercise?

The one principle I reminded myself about as I puffed up and down the pool this morning was this:

There is no point in embarking on a temporary regime in respect of diet or exercise

Why? Because as soon as you stop you will revert back to the weight and fitness level which your long-term behaviour inexorably leads to. Meanwhile you will also probably have a miserable time feeling hungry and exhausted, deep down really knowing that your temporary efforts will be frustrated when you stop.

Much better (and more comfortable and healthy) to make realistic life-long changes in your diet and exercise routines and habits. Of course you won't get as fit and slim as quickly as you might on many temporary regimes but consider the choice: either endure discomfort and make quick progress which is then all lost when you stop the temporary regime or be patient and kind to yourself by making permanent adjustments and so experience steady improvements which can be sustained for life.

The exception to this would be if your GP says you need to take short-term action for reasons of your safety - but that would be unusual.

Have I always stuck to this principle? No, I have felt panicked sometimes into looking for quick fixes and I know that's hard to resist. But unless you genuinely decide to make permanent changes then you are not going to succeed long term: it's as simple as that.

Another good tip is not to try to blackmail yourself into doing exercise by buying a gym membership or expensive equipment. Gyms and suppliers of equipment thrive on people who spend up and then fail and feel guilty, just as many magazines and diet clubs thrive on selling the myth that temporary or cranky diets work.

I do belong to a gym, but I only joined after I had proved to myself that I could sustain a light exercise routine. My gym membership fee is about half what it would be if the members who never attend started to turn up. And of course nobody needs a gym in order to take exercise.

None of this is new. In John Steinbeck's amusing and atmospheric 1945 novel Cannery Row the denizens of this depressed and eccentric sardine-canning district of Monterey decide to throw a party for a popular local scientist and give him presents...

"Eric, a learned barber who collected the first editions of writers who never had a second edition or second book, decided to give Doc a rowing machine he had got at the bankruptcy proceedings of a client with a three-year barber bill. The rowing machine was in fine condition. No one had rowed it much. No one ever uses a rowing machine."

Sardine canneries on "Cannery Row", real name Ocean View Avenue, Monterey, California

Humbug

A sad story about Laura Cunliffe, a young woman with severe mental health problems who has been sectioned many times. She put a kitten in a microwave and it later died - story here.

Today she received 14 weeks in gaol (14 weeks!) - even the RSPCA appeared to recoil somewhat from this excessive sentence.

It's upsetting to think about the pain which the kitten suffered but it was probably much less than a rat suffers when poisoned legally with warfarin - something which happens by the million every day and nobody cares.

So this has nothing to do with animal rights (see my recent post here) but rather our particular culture which finds cats sweet and rats horrible.

And, yes, I share that prejudice and agree with the law which forbids cruelty to cats but allows you to poison rats. But logically you can't really justify making a big deal out of something which is just based on sentimentality.

And, more to the point, we have to have a sense of proportion and some understanding for deeply troubled people.

But amid all the humbug and sanctimonious nonsense spoken by officials in the court the only utterances which had the ring of truth and compassion were shouted by the desperate family from the public gallery as the cruel sentence was passed:-

"She doesn't know what's happening - she hasn't a clue."

"This is a failure of medical services, judge."

Pity them, pity Laura!

Charming

Hafal's Cinderella a few years back in a blaze of publicity aimed at protecting mental health resources

More about mental health services for young people, this time in England. Third sector colleagues across the border have protested about the damage which cuts are doing - and pointed out that this threatens lives.

See the Beeb's story on this here.

Our friends have said:

"The recent decision by NHS England and the health regulator Monitor to recommend cutting funding for mental health services by 20% more than that for acute hospitals completely contravenes the government's promise to put mental and physical healthcare on an equal footing and will put lives at risk...

"Mental health is chronically underfunded. It accounts for 28% of the disease burden, but gets just 13% of the NHS budget. Mental health services are straining at the seams and these new cuts will mean support is slashed in response to instructions from NHS England. This decision will cost much more in the long term as it will drive up admissions to A&E and the number of people reaching crisis and needing expensive hospital care...

"Time is running out; we urge NHS England and Monitor to do the right thing and resolve this issue swiftly."

Sad to reflect that just announcing that mental health will no longer be a Cinderella does not guarantee that she will get to the ball.

And no room for complacency in Wales. We need to make sure that the ring fence on NHS mental health spending in Wales (the nearest equivalent to the English promise mentioned above except theoretically better as it promises extra protection to mental health) really means something.

A different Cinderella (unlike the Ugly Sisters we conform to the Working Time Directive so they did shifts) having her slipper fitted by a passing Prince Charming. Is there no indignity which Hafal's staff will not sportingly undergo in our great cause?

Sardines En Boite

Chartier - unchanged since 1896. They are impatient with tourists, expecting all customers to order instantly, eat and get out

Celebrity oldie and cook Mary Berry has betrayed British tradition by admitting that she serves cheese before pudding at dinner parties - read the shocking story here.

Now I can shed some light on this serious matter...

About thirty year ago I was dining alone in the famous Belle Epoque white collar workers' budget restaurant Chartier on the Rue Du Faubourg Montmartre, sitting opposite a middle-aged Parisian with whom I struck up a conversation.

He said he could not understand why the British served pudding before cheese. Why not, I asked. He replied in utter dismay (I translate) "Do you not see the appalling confusion for your palate of going straight from a savoury main course to a sweet pudding and then back to savoury cheese?".

I had no answer to his charge of first degree food crime and to this day I do tend to eat cheese before pudding.

Like most Parisians my fellow diner's family came from elsewhere but retained their roots - in his case in the Auvergne. He jotted down the names of a few bars in central Paris where fellow Auvergnats hung out to eat their famous sausages and drink their less famous but very acceptable wines - I went to two of them and enjoyed the hospitality of that remote and mountainous region in an improbable metropolitan setting.


Postscript:

In those days Chartier still served "sardines en boite" - meaning a tin of sardines opened and just plonked on a plate still in the tin - 2 francs (20p).

Sounds like a bare-faced Gallic insult...but actually it makes a nice starter.

I just checked and I'm afraid it's no longer on the menu at any price.

Pioneering

Modest but useful coverage on Wales Today last night where I was able to register our concerns about Child and Adolescent Mental Health Services (CAMHS). Follow the links from the Mental Health Wales article here.

A BBC Wales investigation has found that young people are often left struggling to cope without the appropriate support. One expert said there are only half the required staff in CAMHS: Dr Elspeth Webb, a reader in child health at Cardiff University, said there were many good staff in CAMHS, but services across Wales were operating at between 20% and 40% of the recommended staff levels.

My point was that the government's policy and legislative framework is quite good, quite advanced, and they actually listen to patients and their families about what should be delivered. But on the other hand, delivery falls a long way short. We know from anecdotal feedback that patients' and families' experience of CAMHS is very patchy.

The goal of services for children and young people is to intervene decisively at the right moment. Not too early: it's inappropriate and damaging to identify vaguely at risk youngsters and provide an explicit mental health service to them; it's also expensive and probably ineffective to try to provide more than basic information about mental health to all children - and that should be done mainly through the education system.

On the other hand it is of course important not to intervene too late. all the evidence points to much better outcomes even in the long term for children who are helped promptly when their illness is pretty much in evidence - and that means saving money longer-term too. The Government knows this and indeed the Minister of Health Mark Drakeford has spoken eloquently about the need to strike this precise balance.

So the main focus needs to be not on prevention nor on picking up the pieces when things have gone to far but rather on early intervention. That's exactly what Hafal is doing with our pioneering Early Intervention Service in SE Wales in conjunction with the NHS - it's early days and it will be a while before we can report how that is working - but watch this space!

Spring In Your Step

A vignette of Llanelli life this afternoon - everyone is finishing fishing for flounder in the Loughor estuary - it's 2pm and the match starts in an hour! Click on the picture for a better image

Alleluia it's Spring! Well, that's my story and it's a delight to absorb the sunshine yesterday and today. You can feel the Vitamin D welling up and coursing through your veins.

I also discharged a rare DIY duty, managing to secure light fittings and bulbs from Screwfix (that's why I was in Llanelli) and then finding the correct screwdrivers (miraculously not enrobed in hardened glue), remembering to turn off the leckie, and then finishing the job to an impressive 60% accuracy.

But this had to be an outside weekend so as well as the trip to the coast I do two big walks on which I find that the wild garlic is out on south-facing slopes...



This is early but in fact it has been a mild winter in spite of the wind and rain. Good also to see this...



...though not so unusual in the first half of March.

Mrs Blog is a fan of Welsh-Italian celebrity telly chef Angela Hartnett and prepares her recipe (from yesterday's Guardian - you can see it here) for penne con cime di rapa - a peasant staple of pasta and turnip tops - which is very seasonal there being little around at this time of year to stave off scurvy (apart from the wild garlic of course which goes in the salad).

Beware of the recipe's quantities - she says 350g of dry pasta for two but we did 200g, our usual and surely sufficient ration!

Actually we didn't have penne so used those spiral jobs instead. And we didn't have turnip tops but we did have kale in the garden - allowed as an alternative in the recipe. So we really had fusilli con cavolo verde I guess.

The whole meal costs about 40p for two of us but if you don't fancy cooking then you could get Ms Hartnett to do it for you at her Michelin-starred Mayfair restaurant Murano - but multiply that 40p by 400...

On goes the Aldi parmesan - Angela Hartnett calls for pecorino but we had changed all the other ingredients so...

English Punches

In the last few days the UK Government and its supporters have been prodding the Welsh Government about its record on running the Welsh NHS - see the story here.

The critics, led by English Health Minister Jeremy Hunt, have concentrated particularly on death rates in hospitals but they have deployed other examples of alleged failure in recent months. Welsh Health Minister Mark Drakeford has pushed back hard, denying the problems and suggesting political motivation. Well, of course, and no doubt comparison with the Welsh NHS will be a feature of the next General Election.

I honestly don't know who is right about this. Some of the English punches seem to land but others seem off target and the stuff about people crossing the border to avail themselves of superior care in England looks pretty unlikely.

So the jury is out.

But perhaps it is good that the comparisons are made (and let's hope we can see some dispassionate and transparent analysis of relative success) as this may sharpen the determination of both governments to improve their act.

There could be a downside, though, if for example either government devotes undue resources to meeting specific targets - to the detriment of less politically sensitive areas such as mental health. Actually I think there are votes in mental health but it is hard pressed to compete with things like waiting lists for heart surgery.

High Spirits

Sneak preview of the likely logo for our service user and carer-led "Let's get physical!" campaign (actually our excellent Facebook platform got there ahead of me).

The campaign will set a challenge - both to service users and carers and to our service providers - to improve physical health by looking at nutrition, physical activity and access to services.

The campaign will be supported by Hafal, the Mental Health Foundation, Bipolar UK and Diverse Cymru. We met this week alongside members of our service user and carer panel which will lead the charge. We left the meeting in high spirits because we can all see that the campaign will be a lot of fun and do a lot of good too.

It's also a very serious matter. People with a mental illness die on average some 17 years younger than the rest of us - and the physical health of most carers (about 80%)) is compromised by their caring responsibilities.

I have heard users say that it is upsetting to hear these statistics - and it is. The reason we mention it is because (i) it's true unfortunately but (ii) it's something that everybody can do something about by attending to their diet, taking exercise, and using their doctor effectively.

But there is no point in wagging fingers at people about their health - the campaign will let people work together to come up with their own ideas and make the changes they choose to make.

Darwinian Tapestry

The Khmer Rouge of the Carmarthenshire hedgerow resting this morning

Just heard philosopher Roger Scruton on the radio (A Point of View) giving us a lecture about the hypocrisy of "protecting" wild animals and worrying about their welfare very selectively. He's an interesting thinker prepared to challenge orthodoxy when he isn't promoting fogeyish conservatism.

So we kill rats gleefully with warfarin - a horrible death - while wringing our hands about badgers (perceived very inaccurately to be benign - actually they are one of the grumpiest animals you can encounter).

He also takes us to task for indulging domestic animals like cats which massacre the local bird and small mammal population.

Indeed they do, including the rats, also a small mammal and part of God's Creation (as people used to say) or at any rate part of the rich Darwinian tapestry of evolved fauna.

But I plead not guilty to the charge of hypocrisy. We are entitled to make up our own rules as we go along because the concept of "animal rights" is utterly meaningless as the smallest effort of thought demonstrates. In reality our rules about the treatment of animals (most of which I support) are products of culture and taboo not morality.

Those who get confused about these matters run the risk of compromising the unqualified sanctity or, in more secular terms, the unique value of human life.

Such thinking, which sees humankind as of no special importance in the "grandeur of the natural world", sounds clever and contemporary but it can also lead down a slippery slope which in not so distant historical times has seen vulnerable members of society, including people with a mental illness, subject to euthanasia and worse.