Bill's Blog

Yes Sir I Can Boogie

2012-02-12T10:34:00.044Z

To the gym on sunny Saturday morning where I break the still surface of the deserted outside pool creating a shimmer of refracted light like a David Hockney painting (my Mum reports that his new exhibition at the Royal Academy is excellent although she says the rooms aren't big enough for some of the huge works).

The evening takes me to a friend's birthday party which goes very well. For once I strike the right balance over the six hours, spending just five minutes arguing (on my usual hobby-horse about why the oppressive BBC licence fee should be abolished, why should I pay a tax on pain of going to prison to pay for EastEnders and the Vicar of Dibley, etc, etc - all pointless as my collocutors are meeja people) and five hours and fifty-five minutes dancing. In the early hours I compare notes walking home with Mrs Blog who seems also to have enjoyed herself.

This morning the incipient cold I've had for few days has taken a fierce grip so I am attemting to swamp it with sweet tea and settling in to watch the rugby.

Postscript:

Cheesy Iberian disco duo Baccara is often referenced as an example of trite lyrics but I'm not so sure. There is a poetic and subtle, self-satirising quality (and certainly it captures the spirit of last night) in these words...

No Sir
I don't feel very much like talking
No, neither walking
You wanna know if I can dance
Yes Sir
Already told you in the first verse
And in the chorus
But I will give you one more chance.

The alternating "Yes Sir/No Sir" motif is especially effective, in a long tradition of teasing, "can't make my mind up" love poetry. To hear the first verse and indeed the rest of this splendid masterclass in unashamed 1970s hoopla go to this link. And note the hesitant, poorly-synchronised, and yet strangely alluring dance moves. Sensational!

Captain Cat

2012-02-10T12:56:00.001Z

You should all be ashamed of yourselves. I have had more interest in the naming of my new cats than in all the other posts, covering such matters of vital importance as health and social care, criminal justice, blah, blah, since the inception of this Blog.

My favourite was from Hafal's Tracy Lee who came up with Captain Cat and Mog Edwards from Under Milk Wood - D. Thomas is not my favourite poet but the names would have been fun. Both characters are also obsessed with sex which you might think would be appropriate for two tom-cats but not after their trip to the vet next Wednesday for an irreversible procedure. Ronnie and Reggie came up more than once but this could have been in bad taste I guess.

Anyway, all your suggestions were in vain as Mrs Blog vetoed the lot and called them Rhys and Huw (ginger and black notes respectively).

Mistreatment

2012-02-02T11:24:00.003Z

I was very interested in this story from Hafal's Young People's web-site...

Vale of Clwyd MP Chris Ruane has claimed children are under threat "like never before" and there are "dark clouds ahead" because of threats to their mental and psychological wellbeing.

The Labour MP this week secured a debate in which he raised concerns about what he says are the multiple dangers to wellbeing faced by children today, ranging from poverty to self-harm and screen violence.

He told MPs: "Our children are under threat like never before. In the past, threats to children were mainly physical. Many died in infancy, when working, or of diseases. The modern threat to our children and young people is more to their mental and psychological wellbeing.

"There are dark clouds ahead and we all need to monitor this area".

For more on this including both the UK and the Welsh Governments' responses (and for lots of other excellent news and information) follow this link.

This raise two key questions: (1) Does the current social and economic climate increase mental health problems among young people? and (2) Is it appropriate to have a substantial mental health focus in supporting all young people?

No doubt there are young people and others whose mental health suffers as a consequence of unemployment, for example, and common sense tells us that a harsh external world can push more vulnerable people over the edge into serious mental health problems.

However, we should be very wary of letting mental health considerations influence wider policy to any great extent simply because we have got too much wrong already in our ideas and practice concerning mental health.

On the whole the general public has better instincts, better habits and better language for getting on with life and dealing with distressing or difficult events than the ideas purveyed by the "wellbeing" agenda which is the latest buzz in mental health services. Most anxieties and distress, even when somewhat disproportionate to the circumstances, are best addressed through practical support by family, friends, and specialist agencies such as the CAB, not through mental health services, though these should be responsive and well-resourced for those whose troubles reach the point where they are needed.

I know that those who promote the wellbeing agenda do not intend this but the consequence of implying to people that the best ports of call to deal with life's problems are mental health services is to increase the already tragic over-prescription of drugs which numb distress but disempower people from addressing their problems. Wales has one of the worst records in the world for this shocking mistreatment of patients.

President Davis

2012-01-29T20:35:00.009Z

After a refreshing swim at the gym (bright sunshine but the air temperature is below freezing) I drive back and hear a programme on Radio 4 about the battle of the Alamo (1836). Now this blog has a record of exposing famous people as Welsh but it is a departure to reveal a Welsh presence at a famous event...

So step forward Lewis Johnson of Ystradgynlais who stood shoulder to shoulder - and then died fighting - with Davy Crockett and Jim Bowie at this iconic event in the history of the USA (well, actually they were fighting for the Republic of Texas but let's not split hairs).

We shouldn't be surprised as the Welsh played a huge part in the founding of the US. George Washington no less said that the Welsh made great Americans - I'm afraid what he meant was that they were northern European Protestants without great loyalty to the British crown - and as many as a third of the signatories to the Declaration of Independence were Welsh so they certainly featured strongly among the elite - more on this below.

So what happened to them? There are some desultory Welsh societies in the States but they make no real noise, certainly less than the Irish and Italians for example who are very recognisable groups in the US today.

The reason I believe is that they did so well that they don't feel the need to rally around their old flag and they live comfortably at the top of the meritocratic (or culturally determined - take your pick) American class system. There is some evidence for this theory: for example there are lots of Welsh grandees among of the leaders of the Republican Party in Pennsylvania. I have also previously noted the success of one of my recent ancestors in Arizona (see here).

Another sinister bit of evidence for Welsh hegemony in North America is the disproportionate number of black people with Welsh surnames. This is not always, but usually, because slaves took the names of their owners. And of course the one unambiguously Welsh President over there was Jefferson Davis: President that is of the, ahem, Confederacy (1861 - 1865) which rebelled in the cause of preserving slavery and precipitated one of the bloodiest civil wars in history.

All this might disappoint those who espouse the theory that the Welsh are radical by nature but it's no surprise surely. Like everybody else Welsh people can be radical when the circumstances provoke it but given the opportunity they can ruthlessly seek self-advancement and then protect their success in conservatism. It would be mature to recognise this at a time when the responsibility for our success or failure is increasingly in our own hands following devolution.

Postscript:

I check the Alamo story when I get home and it transpires that Mr Johnson may actually have been a Tennessean. But then reliable sources suggest that Davy Crockett (John Wayne in the 1960 film which he directed) actually surrendered (!) at the Alamo and was then shot out of hand by the 14 year-old Mexican conscripts who had stormed the place at great loss. Best stick to the myth.

Cure Or No Cure

2012-01-27T13:48:00.010Z

If you haven't seen it already take a look at Hafal Expert Patient Trainer Dave Smith's recent article in the Western Mail concerning finding a cure for mental illness (the on-line version can be read here).

Though it's his own view I for one don't have any quarrel with Dave's opinion on this important subject. But it is a matter which many are reluctant to discuss and I'd like to consider why. I think that there are a set of reasons as follows with my comments appended:

People are reluctant to raise people's hopes too much - yes, that is a fair consideration, but we must surely be brave enough to discuss the possibilities with people who have experience of mental illness and with their families. Apart from anything else the people doing the science need the active cooperation of patients for research purposes.

Mental illness has been around for years and yet nothing you could call a cure in clinical terms has been identified for the key mental illnesses - true, but then nobody expected the recent exponential advances in understanding genetics: as Dave says discovery of decisive genetic treatments is getting more and more credible.

Mental illness isn't just a question of genetics or brain chemistry ("nature") but also of life experiences ("nurture")so "cure" is an inappropriate term - there are a few hard-line exponents of antipsychiatry who think it's all nurture not nature but most of us are honest enough to acknowledge that we aren't sure but it's probably a mixture, varies a lot between illnesses and individual patients, and frankly we don't yet know enough about this. But it is surely right to look at the biochemistry for cure so long as we also give appropriate weight to the psychodynamic therapies which (and here I'm generalising quite a bit) best address the "life experiences" side of things.

Tricky stuff this both scientifically and politically but let's at least discuss it openly and not hide away in the cop-out which says recovery or cure isn't about real health gain but rather just some woolly ideas about coping and adjustment. Good for you, Dave.

Hedd, Perffaith Hedd

2012-01-26T19:10:00.008Z

To my cousin-once-removed David's funeral out west today, preceded by lunch with my brother and cousin and his wife at Ultracomeda, a deli on Narberth's High Street with a little restaurant attached. The sardines cured in vinegar are very good. We are tentatively approached by other diners we've never met but who turn out to be attending the ceremony and we can share reminiscences from very different perspectives.

Funerals are obviously reminders of mortality but they also have that unique facility of bringing you back in contact in my case with relatives I haven't seen for over 25 years although I had knocked about with them in my teens - it doesn't seem so long ago but suddenly we are all much older! This accentuates the sensation of how fleeting life is but I do not myself find this unpleasant or alarming but rather curiously soothing - you can't really take life too seriously when you realise it's gone in a flash.

But, as Marvell said To His Coy Mistress (circa 1652),

...at my back I always hear
Time's wingèd chariot hurrying near;
And yonder all before us lie
Deserts of vast eternity

- and so you've got to get on with life while you've got the opportunity. This is often called a metaphysical poem but the writer clearly had his mind on the most physical of matters.

Postscript:

As you can see I have two new tom-cats who are so far nameless: any ideas welcome because it would be a shame if they were for ever to be known as the "little b*st*rds" (as in "Hoy there, stop tearing up the furniture you little b*st*rds!").

A Tale From 1796

2012-01-20T13:40:00.007Z

Mary and Charles Lamb

Following my post on Edward Oxford (see here) Hafal's Gail Silver, who is presently moving on from the criminal justice team to join our Time to Change anti-stigma initiative, reminds me that there is another startling historical example of a more civilised attitude to mental illness compared to today...

Mary Lamb, who with her brother Charles published many works but is best known today for their Tales from Shakespeare which is still in print (a snip at £1.99), famously killed her mother while severely disturbed. The legal system in 1796 was not sophisticated about mental illness but it was anything but brutal or thoughtless in this case. Common sense won the day as it was swiftly concluded that Mary should not be punished because she was clearly seriously ill but it was determined reasonably enough that a proportionate degree of security needed to be put in place while she remained a risk. After she had spent three years in a small "madhouse" (not a place of punishment) Charles, who incidentally experienced serious mental illness himself, persuaded the authorities to place her in his care and he successfully supported her thereafter.

There is another point with a modern resonance in this story. Charles certainly paid a price as his sister's carer, sacrificing the potential for his own family life in order to look after her. Now you might hope that modern society would have done a better job for him but some carers today would doubt that as many still have to give up the most basic ambitions for life which the rest of us would see as a right.

Nobody is saying that things were generally better for people coping with mental illness in past times but these stories do give the lie to the idea that society in all respects becomes more caring or compassionate as time goes on. There is definitely an ugliness in our modern legal system which says that somebody must be made to suffer when tragedy strikes even when nobody, if the matter is looked at rationally, can fairly be held responsible.

And, let's be quite clear, this modern approach does not make anybody safer. On the contrary people with a mental illness are made more wary of seeking help if they believe they will be treated unfairly - and that increases risk.

The English Patient

2012-01-19T13:07:00.004Z

Interesting bit of news today that the Royal College of Nursing has come out against the UK Coalition Government’s reforms of the English NHS (see the story here). It seems likely that this will not prevent the legislation proceeding and the changes are already substantially in hand - but it must be worrying for the Government that its plans are still unpopular with health professionals even after the legislation was substantially watered down last year. English Health Secretary Andrew Lansley (above) can't be sleeping very well and must be a candidate for the chop if the Prime Minister reshuffles.

It might be tempting for the Welsh Government to feel a bit smug about all this. In a sense the last Welsh Government went in the opposite direction to the prevailing English approach (which was certainly cross-party - the last UK Labour government was also very firmly committed to the same kind of reforms) by dismantling the last vestiges of the commissioner/provider split which never really got going in Wales both because the old LHBs were absurdly small and also because none of the successive devolved governments have really had their heart in that approach.

But there is a need for some hard thinking about this in Wales. Rightly or wrongly the prevailing model for public services in the EU and more widely in the Western democracies is moving away from top-down delivery and towards a flexible approach in which consumers can exercise significant choice and control. What is Wales’ answer to this? Can the Welsh NHS hold out with a mid 20th Century model as others develop a 21st Century model? I doubt it: we need to heed the winds of change.

However, that is not an argument for aping the changes being made in England where, arguably, the watering down of the legislation removed the opportunities for cost-efficient use of market forces but will still cause huge disruption. Further, the English plan does not really empower patients but rather GPs - and large groups of them not individual practices - so the idea that the GP can order up the English patient's choice of care package is not really a credible vision in the near future.

It would be good to see the Welsh Government open a conversation with consumers of health and social services about finding a Welsh solution to this matter - and I don't mean some kind of nebulous commitment to "listening to patients" which all governments have always pledged to do.

Interestingly the new mental health legislation in Wales could put consumers of mental health services in a good position to take more control. The universal, holistic Care and Treatment Plans which will be rolled out from June would make an excellent platform for giving patients control and choice over their care in the future.

We are a long way from handing control of the budget for delivery of those Plans to patients or their doctors or Care Coordinators (though people already have significant theoretical legal rights over their choice of social care) but in the shorter term it is vital that the NHS and local authorities start to use the Plans as the single means of justifying all secondary mental health services.

If you could match the funding to individual Plans (and I mean all the funding for secondary mental health services - about 80% of all mental health funding - not just some small change) then you would immediately have a transparent means of ensuring cost-efficiency and, in the future, you would have the means to hand over some control. However, I haven’t yet detected any sign of that kind of joined-up thinking - it's not really even on the agenda in Wales - so we’ll need to work hard to get the message across.

Horse Pills

2012-01-13T12:45:00.001Z

Last chance to influence the Code of Practice for Parts 2 and 3 of the Mental Health Measure! Honestly this is more important than it sounds so follow this link and get an email off to the Government before Monday...

It's been a torrid week. On Monday my cat Dusty finally succumbed to old age and Blog Towers is consequently desolate without her friendly and reassuring presence. I particularly miss the way I could go about my business around the house and the cat did likewise without mutual interference - unlike a dog whose needy gaze follows you around intrusively. We will get a replacement soon, or more likely a pair.

Meanwhile, and possibly connected, I have been afflicted by gout in my big toe throughout the week. On this occasion the horse pills prescribed for it (a ferocious anti-inflammatory called Indomethacin) don't provide instant relief but I am banking on a peaceful weekend plus application of a bag of frozen peas (prescribed by Hafal Deputy Chief Exec Alun Thomas) to see it off.

I have previously remarked that the two epicentres for gout in the UK are affluent Surrey and somewhat less affluent Merthyr Tydfil. I have also recently read that the only other beast known to have suffered from gout apart from humans was the biggest Tyrannosaurus Rex ever found. She is called Sue and can be seen in the Natural History Museum in Chicago (picture below). Trust me, you really would not have wanted to run into her when her toe was playing up.

Zealous Newshounds

2012-01-06T12:28:00.001Z

After a few days back in the office this seems a good moment to reflect on what the coming year holds for people with a serious mental illness and their families. Fortunately I don't need to work all that out for myself because those zealous newshounds of our very own Grub Street, aka Mental Health Wales, have done the work for me...

Clearly the biggest milestone of 2012 will be the implementation of the Mental Health (Wales) Measure. The Measure gives vital new rights to service users which could greatly enhance their opportunities for recovery. At the heart of the Measure is a significant new right for users of secondary mental health services to a comprehensive Care and Treatment Plan covering: accommodation; education and training; finance and money; medical and other forms of treatment, including psychological interventions; parenting or caring relationships; personal care and physical well-being; social, cultural and spiritual; and work and occupation. This means that service users will now have the opportunity to take a holistic approach to their recovery and set goals in all areas of their lives.

This key new right is backed up by new rights to advocacy for all in-patients, not just those subject to the Mental Health Act; a right for those discharged from services to reaccess services in a timely way; and by a requirement for Health and Social Services to agree a standard for services at primary care.

Mental Health Wales asks rhetorically whether mental health services will simply pay lip service to the new law or will there be a sea change in service delivery, with a new focus on delivering individuals’ care plans.

I don't know the answer to that but it's a fair guess that we won't see big changes if we sit back and see what happens. There are many skilled and committed managers in our mental health services but they won't be able to revolutionise services without the encouragement and active engagement of the consumers of those services. That's why the key mass membership consumer organisations Hafal and Bipolar UK (formerly MDF) are committed to working with our friends in the Mental Health Foundation on a campaign to promote positive delivery of the Measure. This will certainly be the major focus of our campaigning in 2012 - so watch this space!

Other key issues which Mental Health Wales has highlighted are...

· The Welsh Government will be consulting on its new Strategy for mental health early in the year.

· Claimants in receipt of Incapacity Benefit will continue to be migrated to the new Employment Support Allowance benefit – a process which began in spring 2011 and is due to be completed in 2014.

· "Time to Change", a three-year anti-discrimination campaign run in partnership by mental health charities Gofal, Hafal and Mind Cymru, will be launched.

· A study published in 2011 found that only 1 in 10 prisoners with psychosis are receiving treatment for their illnesses in prison, suggesting that the UK Government’s plans to divert people with mental health problems away from the criminal justice system are not working. We will have to get stuck into this worrying issue.

Postscript:

Driving to work this morning I gain a little insight into the psychology of the Prime Minister. In an interview on Radio 4 he is asked which actor he thinks might play him in a future film with the teasing suggestion of Malcolm McDowell reprising his role as Flashman. Cameron refers instead, and approvingly, to the obscure Lindsay Anderson film "If" (1968) in which McDowell plays a rebellious public schoolboy acting out a fantasy about machine-gunning the teaching staff and assorted big-wigs on Speech Day. In case you are worried about the mental stability of the PM you may be reassured to know that this is something which many or most public schoolboys have fantasised about.

Eloquent

2012-01-05T15:58:00.000Z

Congratulations to Kyle Thomas at Hafal Swansea for his eloquent interview on young people's problems following publication of the Prince's Trust's Youth Index 2012.

See the ITV news item here and link to the report via Hafal's Young People's Information Hub here.

Euthanasia Enthusiasts

2012-01-05T13:29:00.003Z

Supporters of assisted suicide have published a report which they commissioned (see the BBC story here).

There isn't an official Hafal position on this. Our Trustees, the majority of whom are people with personal experience of mental illness, had a very good discussion on the matter a few months ago and, unsurprisingly, there were varying views.

We can all readily think of both theoretical and actual circumstances where a person seeking assistance to take their own life by reason of pain and misery might be unhelpfully disempowered by the present law which forbids such assistance. But that does not mean that the law should be changed. The numbers of people affected by such circumstances are few - indeed in places where assisted suicide is permitted there are not large numbers making use of it - but there is a vast number of vulnerable people who would be deeply affected by a signal from the government that suicide was officially supported as an option for people who suffer serious illnesses.

Opponents of assisted suicide routinely point to the pressure which might be applied to physically frail people and that is indeed an important consideration. But there is a much greater danger that a change in the law could affect people with a serious mental illness. Hafal's staff and volunteers work tirelessly to reduce suicides among our client group - a difficult task when some 10% of people with schizophrenia or bipolar tragically take their lives - and an important part of our therapeutic approach is to show that there is always a better choice than suicide. That approach will be harder to uphold if, in direct contradiction, the government were to signal that suicide is a fair enough option to the extent that it's okay for other people to help achieve it.

Don't get me wrong, I'm not arguing to criminalise suicide (the 1961 Suicide Act decriminalised suicide but also explicitly made it an offence to assist suicide) but that doesn't mean that suicide is "okay". I sincerely believe that a change in the law would result in more suicides by people with a mental illness, not so much because they would avail themselves of assistance (though that could also happen - some "respectable" euthanasia enthusiasts have helped mentally ill people to commit suicide) but because they would see that the government agrees that it is a fair enough option.

There are other sinister aspects to this. I see that drugs advocated for euthanasia in Australia (I'm not going to name them) have been noted by troubled young people there who have then used them to take their own lives - drugs which incidentally are also used to execute people in other parts of the world.

It is also very noticeable that, as much as the argument for euthanasia attracts the sympathy of some decent folk trying to help suffering people, it also attracts a nasty mix of maverick doctors, eugenicists, and macabre death-obsessives - and unfortunately no legislation or procedure will easily distinguish one from the other.

There is a vast risk of terrible if unintended consequences which well-meaning advocates of assisted suicide need to wake up to. I support the BMA and others who understand the issues clearly in resisting the legalisation of assisted suicide.

Dickens vs Olympics

2012-01-01T16:10:00.001Z

Happy New Year!

To the Old Vic on New Year's Eve to see Celia Imrie and other premier division thespians reprising Michael Frayn's Noises Off, his farce about actors producing a farce. This is a neat satire both on repertory theatre and on 20C British farce which the prestigious cast pulls off well if not quite fluently. It really is demanding to play actors rehearsing a play and then to play those actors playing that play badly, if you get me, and they may have needed more time to get this right though there is plenty to laugh at.

I am presently beholden to the Frayn household for my cultural diet as I am reading his wife Claire Tomalin's new biography Charles Dickens - A Life which is excellent. It's going to be all Dickens in 2012 (forget the Olympics) as it's his bicentenary which is a good thing as he has plenty to teach us today. I was particularly intrigued to find that he explored and briefly practised an early form of psychoanalysis in which he examined dreams and the effects of traumatic events in early life through hypnotism and dialogue - I will come back in future posts to this and other important issues concerning mental illness which Dickens touched upon.

New Year's day finds me cooking sausages on the beach at West Wittering, Sussex, with my friend Nick Jarman. This has become an annual tradition but it is sorely tested today by a massive rainstorm which sends everybody running for their cars. But we persevere and get the job done. The trick is to place the camping stove in a big cardboard box so that there is no breeze wafting the flame from your frying pan - this way the cooking takes little time and you can eat before the symptoms of exposure set in.

Festive Horror

2011-12-28T21:58:00.015Z

So that was Christmas and we now face the long haul through to the spring. It is sobering to contemplate that it will not really be warm enough to plant out a marrow seedling until June - nearly six months away, for heaven's sake. However, I draw comfort from the fact that, even though the worst of the winter weather is likely yet to come, you can already see the days lengthening!

My picture above shows the gloomy reality of these shortest of days taken at 3.40pm while I was exiled from the house as the recording of Downton Abbey was played back. Because that festive horror was so long I had time to penetrate far into the woods and take this snap earlier on the walk...

...it doesn't look like much but actually there are about forty deer in the picture as you can just see from this blurry close-up...

Having avoided Downton I decide to give its writer Julian Fellowes another chance by watching his 2009 film "The Young Victoria" which is on the box. The actors do their best but can't make anything worthwhile out of the wooden script which patronises the audience by oversimplifying the subtle development of the young queen.

Her real passion for young Albert, which was truly a great romance, becomes voyeuristic and banal in this film. But the final straw comes when Albert is gunned down by a would-be regicide so that young Vic can nurse him back to health. This of course just didn't happen as the attacker missed completely and the royal couple were unhurt. The writer evidently felt he needed to spice up his plodding plot but in fact the story could have been much more exciting if based on the true story - but it would have to have been well-written.

There is a valuable story about mental illness here too. The assailant with the gun was Edward Oxford who was apprehended immediately and you might have expected him to be harshly treated for his offence. But the 1840 court looked at the case carefully and concluded that he was not guilty because he was mentally ill. He was locked up in hospital but treated well. He was released from Broadmoor some years later and went abroad to make a decent life for himself. There is little doubt that he would have been treated worse today (I mean in judicial terms), between the predictable hysteria about the monarchy and the merciless refusal of the modern justice system to accept that mental illness can be a clear and full defence (see this post).

Dave the Slave

2011-12-25T05:58:00.015Z

Happy Christmas! That's for everybody but a special mention for Hafal Members and others with experience of serious mental illness and for Hafal staff and volunteers working today.

A year ago I mentioned the publication at the same moment as the first Christmas 2010 years ago of Ovid's Ars Amatoria. It occurs to me that it would be appropriate to note how the seasonal festivities were being celebrated across the Roman Empire at that same time.

No, I haven't had a chronological brainstorm. It was customary 2011 years ago for citizens to attend a carol service with readings, go home and exchange presents, and then overindulge in food and drink in an age-old celebration of the birth of the state religion embracing rich and poor alike. I refer to the annual Saturnalia which culminated in late December and dated back some further hundreds of years. The carol service was at the temple of Saturn but otherwise the whole festival would have been recognisable to us today.

One distinctive feature was a role reversal where masters waited on servants or slaves (a custom which persists in some aristocratic contexts today). There are a few reports of this curious activity from antiquity and, if you listen very carefully, you can even hear the slave's point of view from all those years ago...

The poet Horace's slave Davus (let's call him Dave) got his say one Saturnalia two thousand years ago, getting permission from the famous Augustan poet ("Use the licence granted by our ancestors each December to say what you want") to retaliate after years of listening to his master boasting, whinging and pontificating to his friends at dinner parties. Among many well-judged accusations of inconsistency and hypocrisy Dave offers these (my loose translation from Satires 2.7):-

• You constantly complain that everything was better in the good old days "when men were men" but if you actually had to live then you wouldn't have been able to survive.

• When you are in town you go on and on about how much better the country is...and vice-versa.

• If you haven't had any invitations to parties you bang on defensively about how you prefer your own company and the simple life at home but, if you actually get an invite from a rich friend, you charge around hysterically shouting at us to get your clothes ready to go out.

• You scoff at my simple love life with a lady of the night from down the road but what about your furtive affair with a married woman? And who is the slave here when you have to run around meeting her every unreasonable whim?

• In summary, how sure are you that you are worth more than the 500 Drachmas you paid for me?

At this point Horace shut him up forcibly, threatening violence and regretting ever letting Dave speak his mind. Specifically Horace threatened Dave with transfer to work in the fields of his farm in the country - away from his girlfriend and no doubt a lot harder than serving as a butler in the poet's town house. But...

...in fact Horace was a decent chap, the product of the surprising social mobility of those days - his father was a freed slave - and he enjoyed a relaxed and friendly relationship with his servants both in Rome and at his little Sabine farm (pictured in winter above).

Postscript:

What's a Greek urn? About two Drachmas a week. More to the point how much is 500 Drachmas? Dave was evidently a Greek as he refers to Drachmas but a Drachma was essentially the same as four Roman Sesterces. 2,000 Sesterces wasn't a lot for a slave (a healthy girl might fetch 8,000) but was still twice the annual salary of a soldier (who would be a Roman Citizen). But that wasn't a great deal - they signed on for the adventure and to escape grinding poverty. Maybe the best point of reference would be the price of the local wine which Horace - and undoubtedly Dave - would have been drinking at the time of their little exchange. It cost about one Sesterce a litre so Dave was worth about £10,000 in today's money.

Running Dogs of Capitalism

2011-12-19T19:29:00.006Z

Not all the actions of the brutal North Korean dictator Kim Jong-il who died today were absurd. In particular I note that he put the Welsh King of England Henry VII's portrait on one of his postage stamps - something not yet done in the UK in spite of the wily old usurper's canny construction of the modern state, ending the chaotic Mediaeval era decisively by imposing systematic taxation and central control of the legal system.

The first Tudor is overshadowed by his son Henry VIII but deserves much more attention. His claim to the English throne was tenuous in the extreme, partly relying on his grandfather's's marriage to the widow of Henry V but more especially on his mum (Lady Margaret Beaufort, a dour evangelical who founded my College among other good works) who descended from an illegitimate son of John of Gaunt - so, you are right to be puzzled, he had no serious legal claim.

In fact he probably had a better dynastic case, based on relationships with several Welsh princely houses, for being the last plausible "Mab Darogan", the mystical "Son of Destiny" awaited by optimistic Welsh people with a mission to expel the Anglo-Saxons from these islands, following in the footsteps of King Arthur and Owain Glyndŵr.

Indeed he made much of this when he landed in Milford Haven, raised the banner of legendary 7C Welsh King Cadwaladr, and went on to thrash Richard III at Bosworth with many Welsh soldiers in his army including Carmarthenshire hard-case Rhys ap Thomas who struck the infanticidal last of the Yorkists dead with his pole-axe as he was looking for a horse. Henry even called his first son Arthur in the spirit of redeeming Welsh honour but of course the lad died young leaving his widow Catherine of Aragon second-hand (and so contrary to the Book of Leviticus) to his younger brother...the rest is (more familiar) history.

By coincidence I am presently reading the first substantial biography of Henry for many years The Winter King which my Mum has given me for Christmas (I couldn't resist opening it before the big day). It's looking good, offering a balanced view of the old chancer whom I can't help liking.

The Korean stamp (above) uses the best portrait of the monarch in the National Portrait Gallery which is unusually life-like for its time (and seemingly accurate - it compares very closely with his death mask). He looks like what he was: cunning, pragmatic, anti-war but prepared to fight for his own, and intelligent, a contrast to his son's pompous and megalomaniacal portraits and those of many of his dim royal successors. He also looks like a particular type of Welshman with his thin face and narrow, inquisitive nose - a bit like the late, great comedian and crooner from up the road in Ammanford Ryan Davies (see below).

If you are wondering why the North Koreans put Harri Tudur on their stamp then I'm afraid I have no idea. Maybe Kim thought that Henry's successful thwarting of rebellions led by those running dogs of capitalism Lambert Simnel and Perkin Warbeck would send a message to anybody thinking about questioning his position? On the other hand it is difficult to imagine Kim treating a rebel as Henry did Simnel: the generous king pardoned him and put him on a rehabilitative work scheme - turning the spit in the royal kitchen.

Meretricious Tosh

2011-12-15T09:15:00.002Z

Can mental illness inspire great art? This was not a matter I meant to address when I went to Cardiff yesterday but, while Mrs Blog completed the Christmas shopping, I popped into the National Museum to look at a temporary exhibition of David Jones (1895 - 1974) and the question got an answer of sorts.

Welsh visual arts in modern times have mostly comprised soulless, homoerotic or Soviet-style schlock portraits of the "heroic working man", equally soulless and alienating landscapes often including barbed wire, and some third-rate conceptual projects. Boring!

Jones is an exception. His watercolours and occasional oils show intimacy with the Welsh landscape, inviting your engagement and exploration. He has a unique and instantly recognisable style which merges drawing and painting in a striking way. And he uses colour freely to convey mood, delightfully unconcerned with realism.

And yet...

Jones is not a great painter. He got bogged down with spiritual and mythic stuff which lost him valuable focus on simple themes. His work does not develop over his career. In short his pictures all look like the early work of a very great artist. Jones' poetry similarly showed great promise but that promise was never fulfilled.

Why is that? The answer seems to lie in Jones' service with the Royal Welch Fusiliers, in particular at Mametz Wood, where an entire division of Welsh volunteers with no experience and worse equipment and leadership fought for five grim days during the Battle of the Somme (1916).

It is said that many who served in the First World War lost their youthful innocence in the carnage and came home older than their years. But horrible suffering doesn't help young people grow up. It was a common experience in the forward positions on the Western Front to hear wounded and dying comrades crying out to their mothers to come and help them. Many never grew old because they died there but many others were unable to move their lives forward into maturity because they were traumatised by their experience.

Jones came out severely damaged. He clung to his parents who helped as best they could; he sought out father figures like the sculptor and typographer Eric Gill; he had several break-downs and spent long periods unable to work at all; he could not relate successfully to women, causing him life-long unhappiness (he several times illustrates sexuality as a woman lifting her skirt coyly - surely the product of an Edwardian school-boy's imagination not that of an adult?); like others trying to come to terms with their war-time experience he turned to a half-baked spirituality; and photographs of him in old age show a mixture of anguish and boyish innocence.

Great art requires groundedness and accurate and truthful observation, things which mental illness obstructs. This doesn't mean that people who experience mental illness can't be great artists: Vincent van Gogh proves that point but then he was clear that his illness was a hindrance not a help (see this post).

Postscript:

Following these sombre reflections and a satisfactory ingestion of raw fish at Yo Sushi we use the Orange Wednesday 2 for 1 deal to see the new flick "My Week With Marilyn" about the making of the feeble and lumbering comedy "The Prince and the Showgirl" (1957). This is based on Colin Clark's highly suspect "memoir" of working with Ms Munroe in which we are asked to believe that she relied heavily on his moral support and intimate friendship. She goes skinny-dipping with him and lets him sleep in her bed - chastely we are relieved to observe because otherwise this adolescent fantasy would have gone too far.

Young Colin's job was actually to fetch tea for Laurence Olivier and the other actors and I doubt he got more than a few polite "thank yous" from the then Mrs Arthur Miller. I suppose he was jealous of his older brother naughty Tory grandee Alan Clark about whom you just couldn't make it up (see this post). The film is meretricious tosh but quite fun for all that.

Earthy and Graphic

2011-12-13T21:30:00.006Z

I am on holiday and refusing to write about mental health...

My old employer Swansea Sound's weather lady got it right this morning as I heard while running in the gym: "I'm sorry but I can't sugar-coat it - the weather's going to be AWFUL". I found out how right she was when I went outside to swim. And they hadn't put the cover on the pool last night so it had virtually frozen. Is this neglect because ubiquitous smiling beardie and inexplicably popular hippy-capitalist Richard Branson recently took it over? The staff are too busy painting everything red.

The water was bitterly cold on the first length but it got worse as I swam back, this time right into the 50 mph wind which blinded me with a blast of hail. I recuperated in the Jacuzzi feeling I had earned a bacon sandwich at Forte's in Bracelet Bay where I head after mooching for a couple of hours in Swansea town centre.

The sea looks quite calm in Swansea Bay but as I turned the corner past the twin rocks of Mumbles head I could see the rolling high seas beyond. Very cosy eating my lunch with a hot cuppa while looking out on the storm through this old Italian caff's picture window.

Time to reflect that Mumbles is of course so named after the two above-mentioned, breast-like rocks - possibly from the French "mamelles" or Latin "mammillae" but I think from an older Celtic coinage - you won't find a more universal root than this onomatopoeic representation of breast-feeding. We can only hope that Thomas Bowdler, the infamous and much-ridiculed censor of Shakespeare who lived here for much of his life, was unaware of this etymology and so went about his business unembarrassed in the village.

My favourite bowdlerising is in Iago's report in Othello (Act I, Scene I) transforming "I am one, sir, that comes to tell you, your daughter and the Moor are now making the beast with two backs" (Shakespeare) to "...your daughter and the Moor are now together" (Bowdler's "The Family Shakespeare"). Nothing could better illustrate the contrast between the earthy and graphic Elizabethans and the (somehow grubbier?) 19C prudery - so much is conveyed in that coy evasion "together".

Sarky Celebs

2011-12-07T12:20:00.010Z

I'm off on holiday at the end of this week until the new year - catching up with holidays not taken because of my time-(mis)management during the year. I had thought of jetting off to warmer climes but finally agreed with Mrs Blog that we'd rather stay at home and chew the fat. In the teeth of my grumpy and sociopathic tendencies Mrs B has organised or agreed to a series of social events through the festive season which is no doubt better for me than holing up with a book or three for the duration which would be my first instinct.

I give notice that I'm not going to post any worky blogs now until 2012 as I have found, perhaps unsurprisingly, that doing this when I'm off duty does tend to drag my attention back onto professional matters at the expense of the fun and games which should be the order of the day when you are on holiday. It's a "work-life balance" matter - though I hate that term as it implies that work is not a part of your life which is a rather sad way of looking at it, even if on a bad day it might feel that life doesn't begin until 5pm!

I think I might also have to stop watching the news in order to lower my blood pressure. It is not raised by the international financial crisis so much as by the cynical parade of sarky celebs attending the Leveson Inquiry in order to whinge about press intrusion. We are being softened up by these egotists and by the politicians (the most vocal of whom seem to have had their own embarrassments with the press over expenses and other matters they'd prefer us not to know about) for significant restrictions on freedom of speech.

In fact the excesses of the press such as phone-tapping, belligerent door-stepping, and buying information from the police are matters for which there are already legal remedies - they are crimes. If anything we need to take action to protect freedom of speech in the light of the outrageous use by the rich and powerful of super-injunctions and libel laws to shut people up (remember Bob Maxwell?).

Freedom of speech is vital to the protection of poor and vulnerable people - not least people with a mental illness - because the bullies and scoundrels who would like to exploit them are fearful of exposure. In return for this it is a small price to pay if the occasional wealthy film-star or sports supremo is put off his breakfast by some tittle tattle in the paper about his private peccadilloes.

Satirical

2011-12-02T14:27:00.011Z

The Office for National Statistics has cheered everybody up today by publishing the first official study into how happy we are (see the story here). This works in two ways. People who take the study seriously take heart at the fact that three-quarters of us seem pretty happy thank you very much; the rest who think it's a pointless farce for the government to spend money in this way are enjoying satirically the fatuous commentary and daft conclusions being drawn by pundits from these meaningless statistics.

Individual citizens know much better than government what happiness really means to them and would prefer to be left to work things out for themselves. Least of all do citizens need mental health organisations (yes, including Hafal) to start telling them how to be happy; and government would do better to concentrate on its duty to assist those who really need help by reason of their mental illness.

We already have a potent means of telling politicians whether we are happy - through the ballot box. Meanwhile we should all take time to share with each other what makes us happy and to start the ball rolling I will mention squid tempura, fried foie gras slices with piquant cold pickle, and this. I'm not proud.

Justice v Fairness

2011-11-30T15:30:00.001Z

The preliminary psychiatric assessment of Anders Breivik, the Norwegian who has admitted killing 77 people last July, has been published to mixed reactions. As discussed in a previous post (see here) it is important for mental health service users and their families to consider these events carefully because, like it or not, the British public will draw conclusions from the case about the nature of mental illness and what should be done about it.

Some people in Norway are dismayed that he may not stand trial as he was suffering from paranoid schizophrenia. Others, including some relatives of victims, have made measured comments about it not being so important how the illness is seen legally as it is to ensure that the public is protected from him in future.

The case is perhaps most interesting to us in drawing out statements about the system in the UK and I was particularly struck by the comments from Richard Charlton, chairman of the Mental Health Lawyers Association, which relate to the points I made in my previous post on this. He reports that he has represented people who have killed other people believing they are saving them from the devil, but courts have not found them to be insane.

He explains that if the patient knew that killing was wrong, even if God told them to do it, then that's not enough to give them a defence of insanity although it might be sufficient to give them a diminished responsibility defence (which, as the term implies, still means that the person is held significantly responsible). Insanity requires a higher test, and one example he offers is somebody who throws a baby onto a fire in the belief that the baby was a piece of wood and not a baby.

When you consider this it is actually not a fair test because it can convict a person who acts from good (but deluded) intentions and therefore there but for the grace of God go many decent people who might sadly experience a serious mental illness in the future. A police officer who shoots a suspect who points a replica gun at him properly has a defence even though (i) he was deluded because there was in fact no danger and (ii) he knows that killing people is generally wrong: the point is that the police officer acted with good intentions.

The truth is that, as my late father (a lawyer) told me years ago, the justice system is not really fair at all in spite of the rhetoric of some high-minded lawyers and philosophers. In practice justice is a compromise between fairness and expediency - the latter being based on what politicians believe the public will bear. And politicians don't think that the public will tolerate not holding people responsible for their actions even though in practice they had no control or realistic choice over those actions.

The consequence is that patients are blamed for actions over which they had no control whereas they might have been detained for reasons of public protection but at least meanwhile been allowed to establish their innocence by reason of insanity and thereby gained some compassion from society.

This isn't going to change in a hurry but we must be prepared to engage in thoughtful debate. It may be said that following events like those in Norway isn't the best moment to have that debate but I'm afraid the debate is happening as I write, in the British media and in pubs and clubs up and down the country.

Tricorn Hats and Bodices

2011-11-29T16:02:00.007Z

Take a look at Hafal's latest briefing for Assembly Members here which gives a good summary of the key current issues for mental health in Wales, namely...

The Mental Health (Care Coordination and Care and
Treatment Planning) (Wales) Regulations 2011 - more or less a done deal but requiring National Assembly sign-off (due today but delayed as business is disrupted by tomorrow's strike)

The Code of Practice for Parts 2 and 3 of the Measure - currently subject to formal consultation.

The new Mental Health Strategy for Wales - currently being drafted by officials.

Postscript:

My brother Skypes to tell me that the Picton trial (see my last post) featured on telly last night in "Garrow's Law" (I've never seen it but apparently it's a sort of low-rent legal version of Tom Jones - all tricorn hats and bodices) but they got the century wrong and, more disturbingly, the result, oddly neglecting to report the retrial where he got off! Artistic licence is one thing but if you are purporting to reflect real events this is rather misleading - and a reminder to trust reliable sources like this Blog rather than the BBC. Anyway here he is dying at Waterloo...

Brutish and Uncompromising

2011-11-28T07:08:00.002Z

A relaxing weekend catching up with the world beyond Hafal. I have previously commented on the phenomenon of people objecting to the celebration of historical characters because they are found to be wanting by modern standards (see here). The latest manifestation of this is a campaign to remove a portrait of Waterloo hero Sir Thomas Picton from the courtroom in Carmarthen on the grounds that he was prosecuted for torture when he was governor of Trinidad.

Actually he was found not guilty (so you'd think that the lawyers objecting to the picture might respect that verdict?) but in truth attempting to defend Picton on any test of modern moral scruples is a completely hopeless proposition. He was a brutish and uncompromising soldier who would have snorted with derision at this spat.

But the most interesting thing about the Picton trial was that it took place at all. Contrary to many modern assumptions the rule of law did matter then (1808) and it could be used to protect the most humble people from oppression by the most powerful. In this case Picton was prosecuted for allowing the torture of a young mulatto girl suspected of theft who was made to stand on one toe for up to an hour on two occasions - certainly a nasty experience but small potatoes compared with practices found to have been used in our name in recent conflicts. He only got off on appeal because he persuaded the court that Spanish law (which permitted all kinds of excesses) applied on the island as British law hadn't yet been formally adopted - a neat lawyerly defence.

It is commonplace to sneer at our predecessors for barbarism and injustice but can you imagine today's senior British military commanders being seriously held to account for mistreatment of suspects abroad which falls short of death or even injury? In fact little has been done about much worse behaviour, a measure of our moral degradation and disrespect for people of other cultures.

Landmark Moment

2011-11-22T15:22:00.001Z

Time to reflect on the great news that mental health service users in Wales have won the legal right to holistic care plans. Years of campaigning by service users and carers have resulted in new Regulations which give patients in Wales the right to a Care and Treatment Plan covering all areas of life.

The new rights to holistic care planning have been set out in the Regulations for the Mental Health (Wales) Measure which were laid before the Assembly two weeks ago. The Regulations, which cover Care Coordination and Care and Treatment Planning, set out what professionals must do in order to deliver the new Welsh mental health law which comes into effect in 2012. The Regulations are now subject to the approval of the National Assembly on 29th November.

As Dave Smith, Hafal's Expert Patient Trainer, explains:

"The Regulations prescribe a comprehensive Care and Treatment Plan which covers eight areas of life, and they are accompanied by a template which clearly provides a space to address each of these important aspects of recovery in a holistic way.

"This has the potential to transform the service provided to people with a serious mental illness in Wales. It means that all secondary mental health service users will have a legal right to a Plan with spaces for all areas of life to be addressed ensuring that important issues such as accommodation, employment and physical health are covered in their Plans.

"Hafal Members have campaigned for years for the legal right to a comprehensive Plan so to have such a Plan prescribed in law is a massive victory. It’s truly a landmark moment for service users in Wales."

A reminder of the eight "life areas" to be covered in Care and Treatment Plans...

a) accommodation

b) education and training

c) finance and money

d) medical and other forms of treatment, including psychological interventions

e) parenting or caring relationships

f) personal care and physical well-being

g) social, cultural or spiritual

h) work and occupation.

Hafal’s Members pioneered this methodical, holistic approach to recovery from serious mental illness which was based on the experiences of hundreds of people and we published our methodology six years ago. This holistic approach was then rolled out through Hafal’s projects across Wales, resulting in remarkable recovery successes for Hafal’s clients.

Following the organisation’s adoption of the recovery model Hafal’s Members continued to campaign for the adoption of this model across Wales for all secondary mental health service users, and successfully lobbied for the creation of a mental health law in Wales.

The Assembly Member who initiated the new mental health legislation, Jonathan Morgan, said that the most convincing evidence for reform came from listening to the story of service user and Hafal Recovery Practitioner Lee McCabe. More recently, speaking about the Regulations, Lee commented:

"When the Regulations were published in draft it wasn’t made clear that the Care and Treatment Plan would need to include space to address all the eight life areas. Hafal launched a massive user-led campaign which was supported by hundreds of service users and carers across Wales to ensure that the eight areas are clearly given space in the Plans. We are very pleased the Government has listened to our standpoint and amended the Regulations to give proper prominence to the eight life areas."

It is to the credit of the Welsh Government that they listened to Hafal’s Members when we called for a Welsh law and latterly that they took on board the need to include the eight life areas explicitly in Care and Treatment Plans.

The next step is to achieve a robust Code of Practice which prescribes in more detail how health professionals will deliver the Measure; the first draft was published last month and service users feel that it needs to be improved to ensure that the eight areas of the Care and Treatment Plan are routinely addressed, that psychological therapy options are always covered, and that there are clear timescales for agreeing Care Plans.

Of course when the Measure comes into effect in June 2012 it doesn’t mean that it will solve all problems and guarantee a good service. But for the first time it will provide a solid platform of care planning so that people’s needs will be properly assessed and recorded and the required actions agreed with them. From this basis we can build great mental health services and help more people achieve recovery and become fully engaged in society, be economically active, and lead rewarding lives.

Chicken-Sitting

2011-11-19T15:37:00.013Z

I am enjoying a long weekend looking after my brother's livestock out west and taking the opportunity to check out places of interest which I haven't seen before.

Today we head off to Cilgerran Castle en route to Cardigan market. Best known for its scenic position it's fairly run of the mill as castles go but famous for a notorious Christmas party in 1109 which got seriously out of hand when Nest, daughter of Rhys the last king of Deheubarth and wife of a Norman carpet-bagger called Gerald de Windsor, got carried off by local bad boy Owain ap Cadwgan. Or was she seduced and went willingly? Or was it a secret Welsh plot to get her away from her in-laws and start some trouble?

The arguments still rage in obscure Mediaevalist circles but I would just make the observation that Nest seems to have been the ancestress of a sizeable proportion of both the Welsh and Norman aristocracy having put herself about - or been put about, let's stay neutral on this - with everybody from Henry I downwards (the king's son by Nest was Henry Fitzroy or Fitzhenry). What everybody seems to agree is that she must have been the greatest beauty of her era, a veritable Welsh Helen of Troy - shame there are no pictures.

By way of contrast I take a look at the little-known church of Bayvil just a mile east of Nevern church which is itself famous for its Celtic Cross, bleeding yew, Ogham inscriptions, etc. In fact I suspect that Nevern's fame may account for Bayvil's uniqueness as a perfect example of a late Georgian church unnoticed and so unruffled by Victorian meddlers who probably thought it too new and too boring to spruce up and so concentrated on its glamorous neighbour.

As you can see from my picture it is ultra-simple, in-your-face low-church, and dominated by a pulpit which allows the preacher to lean right over his flock and inculcate the Word without any idolatrous distractions. The only symbol in view (and it isn't really a symbol at all but clearly symbolic) is the vast bier for bearing the coffins of deceased parishioners which is stored in full view below the pulpit - an entirely practical arrangement (where else could it go?) but no fancy icon, painting, or statuary could provide a starker memento mori to any member of the congregation whose thoughts might otherwise wander (Lord preserve us!) into a day-dream about the deeds of Princess Nest...

Shifty-Looking Rogue

2011-11-15T13:50:00.001Z

I'm catching up with the pictures from our record-breaking conference last week which saw over 200 eager participants making their way to Builth Wells from all parts of Wales - and they definitely had a good time as we score nine out of ten in the evaluation, also I think a record although we do get consistently good marks for our events thanks to the tireless effort of the organisers and a lot of care taken on the day with our guests who include many very vulnerable people for whom the day is quite a challenge. It was great to see a lot of new faces from new services which we have developed since last year in the teeth of the financial squeeze.

The most popular side-show of the day was the paint job on our life-size model VW camper (the real thing was just outside though represented indoors by our surreal camper tent visible in the picture above).

There is some discussion about the identity of the driver painted in the left-hand seat (correctly - it is left-hand drive), a shifty-looking, crop-haired rogue in a Hafal tee-shirt peering over Tesco Value glasses. Later in the day someone adds a halo which is confusing.

As last year the most stressful part of my day was not Hafal's AGM which passes off in swift good order but the "Camper Cookery Master Class" in which I pretend to prepare a three course meal while our bomb-proof Company Sec Nicola Thomas does the real work, impressively managing not to get food on her posh red sari.

This year we knock out smoked mackerel paté, pitta pockets with griddled beef and mixed vegetables plus couscous, and fresh pineapple with cream and a cherry highlight.

It's all going quite well until I attack the pineapple with a knife and, regretting my failure to practise beforehand, I slash aimlessly at the fruit and in the panic my specs fall off into the sticky juice (luckily they are just Tesco Value ones - a snip at £10 including prescription lenses).

All Aboard!

2011-11-08T18:45:00.001Z

I'm looking forward to Hafal's "All Aboard!" Autumn Rally in Builth Wells this Thursday which is set to break all records with a massive attendance. Hafal Events Coordinator Emma Billings tells me:

"Two hundred delegates have already booked to attend the Rally and the aim is both to offer an opportunity to network and also to explore the challenges faced by people recovering from serious mental illness. This will be a lively event, with different areas for those attending to visit and enjoy throughout the day."

Highlights include:

• "Taking the Wheel" - celebrating the success of the 2011 campaign run by service users with support from Hafal, the Mental Health Foundation and MDF the Bipolar Organisation Cymru.

• The Exhibition Station - an interactive exhibition showcasing Hafal's work across the 22 counties of Wales.

• The Learning Centre - opportunities to meet our team of Expert Patient Trainers, talk to colleagues from Wales' new National Centre for Mental Health and Bipolar Disorder Research Network, get advice and guidance about IT, learning, employment, housing issues and criminal justice, and pick up a range of new publications, FREE of charge.

• Art Corner - getting creative and helping us give our giant model VW camper a paint job!

Emma adds:

"We will also hold our annual meeting specifically for users, as well as an important meeting of the All-Wales Mental Health Carers' Forum - which offers visitors a special opportunity to network with families from across Wales."

As usual I have been unnecessarily poking my nose into the preparations but must resolve to back off and leave it to Emma and her many assistants.

Time-Torn

2011-11-06T20:18:00.014Z

A weekend of sunshine lets me get the bike out for a spin around the Swansea corniche followed by lunch al fresco in the marina - it could easily be Biarritz except I make do with a bacon bap instead of a plateau de fruits de mer and a pot of tea rather than a crisp sauvignon blanc. Not that much like Biarritz then.

Later, on a walk back inland, I discover a curious fungus (not edible) on a dead tree which appears to offer stereo sound (picture below).

Meanwhile in the long evenings since the hour change I've been reading Claire Tomalin's Thomas Hardy The Time-Torn Man. I recommend it as she makes the old melancholic come alive and doesn't bore on with too much literary criticism like so many biographies of writers.

I like Hardy's poetry best and struggle with his novels ever since reading the Woodlanders which starts with 40 pages describing how to whittle sticks in order to make hurdles (whatever they may be). I think the idea was to convey the tedious monotony of country life for the poor and in that it certainly succeeded but at some risk to the reader's patience.

I was reading how Hardy twice interviewed veterans of Waterloo in preparation for a project (the unreadable Dynasts epic) when by chance I heard on the radio that an actress called Norrie Woodhall who knew Hardy well has just died aged 104. It is surprising how closely linked we are to events which otherwise seem distantly historical. Sometimes these links matter, for example in the case of Marshal Pétain who infamously persuaded France to surrender and collaborate with Hitler: as a child he had been enthralled by the stories of an ancient uncle who had also fought at Waterloo (in 1815 for heaven's sake!) and taught him to hate the British...

Business Everywhere

2011-11-06T06:11:00.003Z

Apologies for the the long gap between posts. I was in North Wales for the latter half of last week and the Orange "Business Everywhere" plug-in stick didn't live up to its name meaningfully in room 207 of the Colwyn Bay Travelodge. I did try but felt like the telegraph officer on the Titanic attempting to transmit letter by letter with a desperately slow connection (well I suppose he was more anxious than I was).

Anyway, the important news is that Lee McCabe has now published his campaign on the Code of Practice for Parts 2 & 3 of the Mental Health Measure. This sounds boring and technical but don't stop reading! Honestly, this Code sets out in practical terms how Care and Treatment Plans must be developed for all users of secondary mental health service. It may therefore be even more important than the new Mental Health Strategy currently being written.

One of the three issues that Lee raises is about timescales, both:

● from referral by a GP for assessment for secondary mental health services
to that assessment being carried out; and

● from assessment as a "relevant patient” (needing secondary mental
health services) to the completion of the required Care and Treatment Plan.

There is guidance on assessment timescales under part 8.9 of the draft Code
but this relates to Part 3 (which concerns former users of secondary mental
health services) and it is not mentioned in relation to Part 2 (which concerns
care planning).

The timescale for getting assessments done needs to follow the Welsh Government's own timescales for assessment set out in its interim community mental health team guidance which says that:

- Emergency referrals will be seen within 1-4 hours;
- Urgent referrals will be seen within 48 hours;
- Routine referrals will be seen within a maximum of 4 weeks, but usually much sooner.

And there should be clear deadlines for the creation of Care and Treatment Plans following assessment as a “relevant patient”. Lee suggests:

- Plans must be created a maximum of 6 weeks from assessment under most circumstances
- Plans must be created a maximum of 12 weeks from assessment even in the most exceptional circumstances.

To read all Lee's points, and for links to the draft Code and other key documents, follow this link. You can also find there a link to Hafal's own draft response to the consultation - we are trying something new by showing our work in progress and you are welcome to contribute.

Lee's position already has the support of the Mental Health Foundation and MDF the Bipolar Organisation as well as Hafal so we are confident that this campaign has legs and we can achieve vital improvements to the Code.

Big Friendly Village

2011-10-30T20:47:00.002Z

Another active weekend in the teeth of wet weather, the highlight being a walk on the coast path near Llanelli. The tide is in and occasional sunlight breaks through to create a silvery shimmer which needless to say my photos fail to capture.

The centre of Llanelli is mainly covered in scaffolding as an EU-funded facelift gets underway. I'll reserve judgement until I see the result. I have wondered whether the vast expense of renovating Llanelly House, former home of local crachach the Vaughans and latterly Stepneys, is worthwhile - the building was abandoned as a town house for the gentry in about 1800 and used for business and suchlike since - but the die is cast and we should find out next year.

This unique Welsh community, where the same industrial and non-conformist character which once made it modern and progressive now makes it appear very old-fashioned, does not conform to the characterless and impersonal uniformity of modern urban environments (well, outside the central pedestrian shopping area anyway) either in appearance or, more importantly, in its social atmosphere which remains like that of a big friendly village.

Meanwhile the Coast Path Visitor Centre stands out improbably as a bold bit of modernism...

Inexplicable

2011-10-28T15:44:00.013+01:00

Swansea City Premiership celebs Gerhard Tremell and Vangellis Moras visited Hafal’s Ammanford Resource Centre this week and had an in-depth discussion with service users which touched on the parallels between recovering from a serious physical injury and a serious mental illness .

The event was a great success: Huw Lake (Player Liaison Officer), players and service users also discussed issues including social isolation, positive mental attitudes in competitive sport and recovery from serious mental illness.

One other topic was the stress of working in a competitive environment, something a professional footballer isn't really going to be able to avoid but it will get a lot worse later in the season as the titanic struggle to escape demotion comes to a head. Jack Army stalwart and Hafal Deputy Chief Exec Alun Thomas thinks they stand some chance as their home goal remains watertight...so far.

I'm strictly neutral as there are a number of Cardiff supporters among us - both clients and staff - who inexplicably failed to join in the celebrations when their neighbours down west went up.

Keith Wins Oscar

2011-10-26T14:04:00.015+01:00

Keith Jones (centre) with fellow award winners and BBC Wales Today presenter Lucy Owen (far left) and Health and Social Services Minister Lesley Griffiths AM (second left)

Congratulations to Hafal's Keith Jones who has won a Gold award at the prestigious Wales Care Awards 2011 - the "Oscars" of the caring world.

Keith, a widely-respected Practice Leader based in Bridgend, was presented with the "Promoting Fulfilled Lives" Award at a ceremony attended by Health and Social Services Minister Lesley Griffiths AM at City Hall, Cardiff on October 21st.

Keith was nominated for the award by a service user who has since moved from Hafal's halfway house in Bridgend to his own accommodation and said: "Everybody who has worked here and has lived here has enjoyed his company. He is fun to be with and is friendly and understanding." And Keith's colleagues, who are delighted at this richly-deserved recognition, all echo that view.

Keith, a native of Pyle, Bridgend, worked as a taxi driver for six years but an interest in the caring profession saw him switch to work with adults with learning disabilities and latterly with people recovering from serious mental illness. Keith says he derives great satisfaction from seeing service users achieve their goals.

Cool threads too, Keith...

Blitz

2011-10-23T18:10:00.001+01:00

Trying to catch up with a minimum level of fitness I do a gruelling gym yesterday and a couple of long walks today. The autumn has set in properly - the devil has p*ssed on the blackberries (as country folk charmingly put it) so Mrs Blog has moved on to collecting chestnuts, her only serious competitors being the local Chinese community (well, one family actually) so there is plenty to go around.

Of course there's nothing better than just roasting them on the fire but if you want to keep them pop them in boiling water for five minutes and the skin can then be cut away easily and you can freeze the edible insides - quite a valuable crop. Ours is being saved to stuff the Christmas bird and some other delicacies.

This is also the time for pumpkins which are fun for Halloween but should also be used to make this fabulously creamy and yet not at all unhealthy soup...

Toss 2 lbs pumpkin flesh (cut into chunks)and 6 whole unpeeled garlic cloves in some olive oil then roast at 400F for half an hour. Meanwhile finely chop two onions and 2 celery sticks and fry in the bottom of a large saucepan in some more oil. Add 2 1/2 pints of good chicken stock (best you can manage - the quality will depend on this), 2 oz rice, plus the pumpkin and garlic (remove the skin first); simmer for 15 minutes then blitz in a processor (or whatever you use) until creamy. Season well and reheat to serve with some parsley on top.

You can add a bit of cream when you serve to fancy it up but there's really no need. If you don't like garlic or you are vegetarian best find another recipe - you'll need some other flavours and there are plenty of variants on-line although they won't be as good as this one.

Postscript:

So the French put up a good fight but went down to the favourites. What might have been if we had made the final as justice demanded! Ho hum.

Allez Les Blancs?

2011-10-21T13:05:00.001+01:00

So Wales came fourth let down again by their kicking. Attention turns to the final and I'm coming out for France which I know is not the done thing around here. But they have sportingly agreed to wear white whereas they could have made the All Blacks change. Julien Bonnaire says they should have stuck to their rights especially since the NZ media is full of stuff about Gallic naughtiness like eye-gouging. As if his consummately sporting nation would ever stoop so low.

In the end you've got to support this mutinous, shabby and chaotic outfit because it would be so remarkable for them to whip their confident hosts. But I'm not holding my breath.

And Another Thing

2011-10-21T10:12:00.002+01:00

Since my last post Hafal's policy expert Peter Martin (pictured above with Darren Millar AM last week) has read the draft Code of Practice more carefully than me and points to the absence of clear timescales for the critical periods (i) between referral and assessment and (ii) between assessment and completion of a Care and Treatment Plan.

Of course we all recognise that there needs to be some flexibility for different circumstances but words like "timely" and "appropriate" aren't good enough: we need a specified range of times including a maximum time only to be exceeded in the most exceptional circumstances.

A particular concern, especially of some carers for obvious reasons, is the problem of creating Care Plans for people who refuse to engage with services - often because they do not accept that they have an illness. These patients can be floridly psychotic and very vulnerable but Hafal staff have lost count of the number of times we have been told that "he/she obviously can't have a care plan because they won't cooperate".

This is entirely wrong. It is difficult to develop a plan in these circumstances but much can be put in place through engaging with carers and others in touch with the patient including their GP. At the very least the Plan needs to include contact with the family to help them support the patient and scheduled checks on the patient's health and safety and attempts to encourage the patient to engage; and some imaginative ways of getting help to patients should be considered, for example through oblique offers of help concerning physical health, housing, etc which the patient may accept (and of course holistic care planning particularly supports this approach).

The Code does address this issue but it also needs to give specific guidance on timescales in relation to these patients, in particular prescribing the necessity to develop a Plan more urgently for them. Otherwise, believe me, development of Care Plans will be delayed on the excuse that the patient would not cooperate.

This is a delicate area but there is no room for political correctness here. It is folly to delay formal care planning because you are waiting for the patient to "come around to it" - the Plan must be created quickly even if the patient isn't cooperating and it can subsequently be reviewed and improved cooperatively just as soon as the patient chooses to engage - which the Code does point out.

Talk of the Devil

2011-10-19T09:40:00.024+01:00

As fast as I pressed the button to publish yesterday's blog we received the draft Code of Practice that I was talking about (follow this link). A quick read suggests that the Government has done a good job on most of this, including welcome detail on the 8 "life areas" and clarity about these being systematically considered in assessments of need. Two bits in particular need improvement I think...

(1) The guidance as drafted on completing a client's Care and Treatment Plan would lead some practitioners to believe that in many cases it would be sufficient to address just two or three of the "life areas" in the Plan. In fact clients need a plan for all the life areas (except, in some cases, clients' parenting or caring responsibilities). That is not to say that mental health services have to take action in all the areas - in many cases other agencies will be involved or indeed the clients may address areas of their Plan by themselves.

One example: if a client is comfortable that they can manage their own housing needs that does not mean the "Accommodation" life area should be left out of the Plan - because the client definitely needs a plan for where they are going to live in the coming months! Rather there should be a simple statement such as "x lives in a Housing Association flat and is confident that he/she can manage rent and services payments, general maintenance of the flat, and relationships with their landlord without support but will contact the Care Coordinator if problems arise". Job done.

A statement of this sort ensures that the "life area" is covered, recognises the responsibility of the client (which is appropriate and in itself therapeutic), and incidentally covers the practitioner very effectively if problems should arise.

By contrast if there is no mention of accommodation in the Plan it will be unclear whether this means (i) there is in fact no action required by mental health services or (ii) another agency's help is needed or (iii) indeed the client can manage for them self or (iv) the matter has just been overlooked or gone unrecorded. This is deeply unsatisfactory and unsafe considering a few words could have transparently cleared the matter up for everybody's benefit.

(2) The advice on the treatments for mental illness "life area" does not specify that both medical and other treatments (including psychological treatments) should be covered in the Plan. Otherwise, frankly, the common practice of not even considering non-medical treatments will persist for many or most clients.

If indeed either medical or non-medical treatments are not appropriate it would be good to read in the Plan words such as "It is agreed that psychological therapies are not appropriate at present". I know it can be argued that this will have been covered at the assessment stage but in practice it is vital to have this clarified in black and white in the ongoing Plan, not least so that at review the matter will be reconsidered.

Hafal's view originally was that there should be quite separate consideration of the two sorts of treatment in Plans rather than dealing with them together. Apparently the amalgamation came as a result of well-meaning people not wanting to dignify medical treatment too much as a distinct area. Understandable perhaps but in practice we risk losing due cosideration of non-medical treatments unless this matter is very clearly addressed in the Code.

I hope the Government, which should take great credit for painstakingly bringing forward this radical and ground-breaking legislation, will go the extra mile and improve the Code in order to prescribe without ambiguity a truly holistic approach to mental health which embraces the responsibilities of patients as well as of professionals and modern talking therapies as well as medicine.

Anyway, enough from me. I'm delighted to report that Lee McCabe, veteran campaigner for the Measure (indeed he's actually the person who instigated it as acknowledged by Jonathan Morgan, the former AM who got the ball rolling with the LCO) has agreed to dust off his armour like Cincinnatus and take the lead in a public campaign on the Code - watch this space...

Here's Lee chatting to the Minister last week: apparently she suggested he puts his role in initiating the Measure in his CV - good advice!

Another Day Another Dollar

2011-10-18T09:52:00.009+01:00

Well, I'm back from my holiday and attuning myself again to the world of work. It feels a long time until next summer as I'm swimming outside in the dark each morning (in the heated pool at my gym I hasten to say) until the hour change at the end of the month - but there's no escape as that will herald travelling home in the dark for the next few months.

It's not really natural to spend all the daylight hours indoors but (on the bright side) working outside isn't much fun in the winter and I suppose it's better than working down a mine where, if you had a day shift, you might not even see daylight for days at a time.

This seems like a good moment for taking stock of what we've achieved this summer. The "Taking the Wheel" campaign has really caught everybody's imagination. In particular our messages about putting patients at the heart of services - for real I mean, not just as a stale old mantra - have really landed and I have some optimism that the Government's new Mental Health Strategy will be built on the individual Care and Treatment Plans at the core of the Measure which Hafal Members instigated several years ago. Those Plans will need to focus systematically on the eight holistic "life areas" which Hafal pioneered and which are included within the law itself.

Of course there is more to do. the Regulations for the Measure will be published shortly as will the draft Code of Practice - we need to ensure that the Code is at least as clear and prescriptive as the Government's Interim Guidance on CPA currently in force - so make sure you get to one of the consultation events (details available from Hafal if you haven't got them).

See our report from "Taking the Wheel" here.

An Echo of 1980

2011-10-15T10:52:00.005+01:00

Oh dear, oh dear, oh dear what a travesty! And am I alone in detecting an echo of 1980 in today's game? Back then England beat Wales 9 - 8 against the tide of history following the controversial sending off early in the game of my hero and fellow-flanker Paul Ringer, one of the seriously hard men of Welsh rugby - that's putting it politely and I don't suppose Sam Warburton would take too kindly to being compared with this legendary tough.

Like today on that occasion Wales won on tries (2 - 0 in fact - only four for a try in those days) in a game that was dubbed the "Battle of Twickenham" because of the brutal aggression shown by the Welsh from the start. Indeed the sending off was a case of making an example following a lot of fierce play, something which today's ref could not point to.

I was at university (in England) at the time and watched the game at a friend's house with a crowd of England supporters who became prissy and self-righteous about the uncompromising Welsh tactics and I took a lot of stick naturally when England kicked their winning penalty in the closing seconds.

I've still got my "Paul Ringer is innocent" T-shirt somewhere.

Savages

2011-10-13T17:14:00.001+01:00

I lived in Haverfordwest for a few months many years ago but until today I had never visited St Mary’s Church. It’s not much to look at having lost its steeple 200 years ago and it’s boxed in by 18C development - though that is not so objectionable compared with the criminal damage committed by 20C planners on the lower end of the town (it was here that I first observed the phenomenon of local government colluding with greedy local businesses to suppress the flexible, transitory and seasonal local economy which market towns had previously offered, not least through low-rent market stalls).

Inside the church looks a mess too, littered with memorials of the Philipps family, the local big-wigs from Picton Castle. But if you squint and abandon close focus you can see a nice 13C church combining solid local craftsmanship with some French frills, notably the finely carved arches in the nave. The roof is Tudor – spot the giveaway roses.

Dominant minorities often mock the majority which surrounds them out of nervousness of dissent and rebellion. The English-Flemish colony here was no exception and used the opportunity of building the church to take a pop at the savages eyeing them
resentfully from north of the Landsker. There are amusing satirical carvings of their neighbours in the form of a monkey playing the Welsh harp, a pig playing a Welsh fiddle, and a carousing Welsh hooligan brandishing a very modern-looking pint tankard.

I should also mention the memorial to Sir John Pryce who kept the embalmed bodies of his first two wives in his bed, unable to sleep without their comforting presence. His third wife most unreasonably put her foot down and made him shift them out.

An Excellent Metaphor

2011-10-12T20:55:00.008+01:00

I'm on holiday so catching up with events in the world of Hafal. Delighted to see the pictures from the Senedd yesterday where our report from the "Taking the Wheel" campaign was launched in the Oriel Gallery by Health and Social Services Minister Lesley Griffiths AM.

The What Users Want! report provides feedback on the popular, client-led campaign which Hafal has been supporting in partnership with MDF the Bipolar Organisation Cymru and the Mental Health Foundation. The campaign empowered mental health service users to take control of their lives and the services they receive.

Backing the campaign's objectives the Minister said: "Taking the Wheel acts as an excellent metaphor for the recovery approach in mental health - something which I strongly support - where people, working with professionals, can take control and drive improvements to benefit their mental health, and be directly involved in their care and treatment.

"This is in line with our commitment to use the legislative powers of the Mental Health Measure. From next year, this will mean mental health support services will be available within primary care in all local authority areas, and service users will benefit from integrated and individual care and treatment plans."

The campaign encouraged people receiving secondary mental health services (or those who have serious mental illnesses such as schizophrenia, bipolar disorder and other diagnoses which typically require high levels of care) to take the driving seat in managing their own recovery from serious mental illness.

The clear message emerging from the campaign is that service users want help across a wide range of Care Planning areas. Significantly, service users view the Care and Treatment Plan as the means of ensuring that mental health services are shaped by patients' needs.

Hafal Expert Patient Trainer Dave Smith explained: "I've spoken to a lot of fellow service users during the campaign and the consensus is that we don't expect vast new resources for mental health services. We know that this isn't going to happen anyway. But we do want client-centred services. And we're agreed that this can be can be done concretely by using Part 2 of the Measure which concerns care planning.

"Service users want individual Care and Treatment Plans but it's not good enough to make these Plans fit the services available. Services should be based on what's in the Plans, not the other way round. And there should be enough flexibility in the provision of services so that they can meet every individual's needs."

Quite so, Dave, and roll on 2012 when the Measure comes into force and we can help all users of secondary mental health services and their families to take control.

To read "What Users Want!" go here; to listen to the Minister's speech go here.

Episcopal Purple

2011-10-09T19:44:00.004+01:00

Hafal's employment lead in South Wales Andrew Mulholland's 80 to 1 bet on Wales to win the Rugby World Cup looked even less unwise at the crack of dawn on Saturday as we saw off the rampant Irish and proceed to the semis next week against an inconsistent French side. Maybe it's evens to win that one and 5 to 1 to win the final against New Zealand (or conceivably Australia) which means 10 to 1 are the current odds - so Andrew should only contemplate selling his slip today for 8 times what he paid for it but I'm sure he won't.

After the match I set off to fish but the met office "computer says no" and my only catch is a set of autumnal pictures. See above what is usually a good mark for pollack and wrasse but today would be a death-trap for shore anglers as 20 foot waves crash over the rocks, though I notice that the shags, which on a calm day dry themselves on the island opposite, calmly continue to fish in the boiling seas.

The picture below shows the amazing coloured rocks in a beach cave at low tide. If you are familiar with St David's Cathedral you will recognise the two shades of episcopal purple sandstone which was quarried here and dragged a mile north to the building site nearly 900 years ago.

Quadrille

2011-10-07T16:27:00.001+01:00

Interesting report here on the Hafal young people's web-site about a discussion between our Young People's Information Hub lead John Gilheany and the Health Minister. I won't repeat the whole thing (go look!) but I admire her straightforward honesty about how young people can behave. And I mean as we behaved as young people too - this is not one of those fogyish "These young people today!" remarks. She said "If we can educate our young people who tend to be a bit crueller when they're faced with someone a little bit different, that will really help".

Of course young people can be as compassionate as anybody else but I think the Minister is alluding to that phenomenon of children following the herd. Even the nice kids get caught up in the cruelty. Unless you were very brave I suspect that like me you will remember joining in a group to tease a victim towards whom you would have been sympathetic one-to-one.

Adults too can be hostile to difference even when it is completely harmless. I'm reminded of Edward Lear's curious limerick...

There was an Old Man of Whitehaven,
Who danced a quadrille with a raven;
But they said, 'It's absurd
To encourage this bird!'
So they smashed that Old Man of Whitehaven.

The last line is startling as it seems such an over-reaction. But Lear was a thoughtful man and this poem illustrates the deep-seated resentment people have towards eccentric behaviour - it's almost as though they feel they are being made a fool of and this is subtly, I think, at the root of some of the hostility towards people with a mental illness: at some subconscious level people think that the person behaving oddly because of their mental illness is actually mocking them.

Not So Boring

2011-10-05T15:05:00.005+01:00

Stifling a yawn or two I've been dutifully reading the Welsh Government's "Programme for Government 2011 - 2016" which includes some useful and some more woolly commitments about mental health - a useful commitment to individual care planning but a woolly promise to "review" access to talking treatments. See the details here.

You can detect the First Minister's own hand on the approach they are taking which is to emphasise delivery rather than reform in public services and specifically to concentrate on things which citizens actually notice as changing for the better in their individual lives. All Carwyn's recent rhetoric has been about this.

You could be cynical and wonder if this is a sign of an administration bereft of big ideas or the "vision thing" - or else you might wonder what previous governments were doing if it wasn't improving individual lives! But Carwyn is a canny fellow and probably realises that the public are a bit fed up with big ideas and looking for a spell of boring but functional government while we creep along in these dire economic times. Anyway they just can't afford to do much new and interesting.

Looking at this positively I think we should work on (and with) the Government's instincts about the way ahead and show them simple, cost-effective things they could do to improve the lives of people with a mental illness and their families.

Here's one example which a patient who was concerned about losing contact with families gave us: "In-patients should have video contact with their homes – available via IT systems such as Skype". Good plan - it would cost peanuts compared with the eyewatering cost of in-patient care and surely save money (even short-term) by promoting recovery (and earlier discharge) for people in hospital through the comfort of sustained contact with loved ones.

Lots of practical ideas like that could add up to making a really big difference in mental health services - not so boring after all?

Baroque

2011-10-05T07:10:00.002+01:00

Back for a moment to my piece on Don Giovanni (see here).

My nephew Richard who lives in Spain writes that the fate of Don Juan in literature ("Don Giovanni" is the Italian for this originally Spanish character) has varied according to the state of play in religion and politics...

"El Burlador de Sevilla y el Convidado de Piedra" (the Trickster of Seville and the Stone Guest) was written in 1616 during the Spanish Baroque period by Tirso de Molina, a Roman Catholic monk and the founder of this literary device. In his story Don Juan doesn't change, is unrepentant and bound to his worldly desires and so is punished with damnation. The ideas of the Renaissance have failed and people look for escape in the heavens. It is a time of great stoicism. The play is an inspiration to aim for the higher spheres.

By contrast in "Don Juan Tenorio" written by José Zorrilla in 1844 during the Romantic period the story is the same but with the twist that Don Juan is repentant and in the nick of time he is saved by the love of Inés the nun. This is a post-Enlightenment play: man is inherently good; the religious themes are from Zorrilla’s upbringing as a modern Catholic.

Incidentally Richard tells me that the latter play is performed all over Spain every year on All Saints Day because of its ghostly theme.

Perhaps all this adds credence to the view that it was odd for Mozart to go for the damnation option but of course he did predate Zorrilla so it may simply not have occurred to him to look for a happy ending. And as an Enlightenment man he just wouldn't have taken hell-fire seriously (so he isn't really in the Tirso camp even though he's faithful to that plot) whereas the Romantics might have found it disturbing?

Glad we've cleared that up.

Excellent

2011-10-03T12:20:00.002+01:00

Good to see that the BBC has published John Williams' excellent photo of the Towy Valley taken from Dryslwyn Castle (see above and online here). John has only recently taken up this hobby attending digital photography sessions at Hafal's Ammanford Resource Centre on Saturdays. The sessions are ably managed by Rosemary Andrews who has a background in professional photography though her present "day job" is the very important one of paying expenses to Hafal's clients and staff among other vital tasks.

I know exactly where John's picture was taken - you can see me standing a few yards away here!

Never Say Never Again

2011-10-03T08:29:00.010+01:00

A surreal weekend which seemed to last a long time in spite of being good fun - a rare combination. The record-breaking weather inspires a final flurry of summer (summer?) activity. On Saturday I ascend into the foothills of the Black Mountain, that bleak and unnoticed western portion of the Brecon Beacons National Park, to swim in the upper reaches of the Usk - about a mile below the source and 55 miles above its muddy end in Newport.

Thirty years ago I camped illicitly with college friends at this pool and in the morning was confronted by an irate official in a silly uniform reminiscent of the Park Warden whom Yogi Bear routinely outsmarts in Jellystone National Park. But this jobsworth was not outsmarted because he asked who was in charge and an idiot friend gave him my real name (instead of "Ludwig Wittgenstein" as we usually said when cornered by the authorities - I recall on another reprehensible occasion finding it difficult to keep a straight face when asked to spell it by a different kind of uniformed official with notebook in hand - and now you know why I'm against bringing in national identity cards) so I spent a nervous few days awaiting some kind of oppressive contact from the law - none came of course. I think today I would be more resilient and defensive: I'm not sure I could anyway take seriously anybody telling me I couldn't camp out in the wilds (quite the rebel, eh?).

On Sunday I'm swimming again, this time in the sea next to County Hall in Swansea. High tide is at 10.20 am and the water is already comfortably warm. You really have to take every chance you get - we didn't get much luck in August so swimming in October is an unexpected gift. I guess this will be the last opportunity this year but you never know...

Last But Not Least

2011-09-30T12:34:00.006+01:00

The "Taking the Wheel" campaign rolled into Swansea yesterday for the last of 22 county visits - and what weather! Quite a challenge for the 1964 microbus which of course has no radiator but improbably relies on air blowing through side-vents to cool her diminutive and under-powered engine.

Service user Sarah Stanyon, 23, who has depression and Post Traumatic Stress Disorder, tells us: "Before going into hospital I felt trapped in a downward spiral. I couldn’t see any light at the end of the tunnel, I couldn’t cope with many day-to-day activities, and I really felt like the mental health services available from the NHS were not helpful.

"Since being admitted to hospital things have changed. Hafal found a social worker to talk to my parents about my treatment and after hearing their views of how poorly I had been treated the social worker got to work. I now have a Community Psychiatric Nurse, I will have a home of my own soon and I will be returning to education shortly. I feel my mental health is being taken seriously and this, along with the developments that are taking place in my life, has made me feel empowered.

"Without the support of Hafal over the last year I would not be where I am today. The services they have provided have increased my confidence and opened my eyes to new experiences and ways of thinking. I’ve also made some friends along the way, too."

Thanks, Sarah, for an uplifting story to mark the end of this summer's remarkable campaign alongside our partners and friends in MDF the Bipolar Organisation and the Mental Health Foundation. Not that this is really the end - the microbus can be rested up but we will be carrying messages from the campaign to the Senedd on 11 October where we are celebrating World Mental Health Day with the Minister of Health Lesley Griffiths AM. I'll do a link to our joint report when it is published next week.

The Optimism of Recovery

2011-09-29T12:06:00.006+01:00

Congratulations to Nerys Price from Hafal RCT who was awarded first prize in the Wellbeing and Recovery art competition at the Mental Health Research Network Cymru Annual Conference held at the Millennium Centre in Cardiff. The judge said Nerys’ picture best portrayed the "optimism of recovery".

From Dusk to Dawn

2011-09-24T07:40:00.010+01:00

In 1990 when I was working in youth crime prevention I accompanied a crowd of teenagers from Mountain Ash to see the recently released Ghost, the slushy but popular film starring Demi Moore and Patrick Swayze. The setting is modern New York and the characters are everyday and naturalistic but when the villains in the story die they are seized by howling demons and dragged screaming into hell, watched over by Swayze's saintly ghost - he was murdered at the start of the action. The contrast of modernity and literalist mediaeval damnation is startling.

Last night I see Welsh National Opera's new blockbuster Don Giovanni at the Millennium Centre. It is a very well done if not quite historic production and I enjoy the witty portrayal of human folly which affects all the characters as the Don (David Kempster) seduces, murders and deceives through two and a half hours until finally this colourful antihero is seized by howling demons and dragged down into hell under the supervision of the saintly ghost of the "Commandatore" whom DG knifed in Act One.

Since its first performance in 1787 people have wondered why Mozart and librettist Lorenzo Del Ponte introduced this massive shift from an "everyday" human story to one of eternal damnation. Wasn't Mozart a man of the Enlightenment, they say, indeed a Freemason; surely he didn't believe all that stuff? Of course not - it just makes a great story with an amazing twist. And unlike the predictable Ghost with its simplistic, black-and-white characterisation (indeed there are casually racist undertones distinguishing the two-dimensional goodies and baddies) the opera has unexpected qualities including Don Giovanni's response to the ghost who offers him the chance to repent at the very gates of hell - no, he says, get lost you old fool. You have to admire his guts! See this version with Bryn Terfel on YouTube which illustrates how unexpected the scene is in a Mozart opera. It looks more like Wagner except of course the music and words aren't rubbish.

The funniest bit about the opera is the anticlimactic final scene (often left out in the past by humourless producers) after the Don has been dragged away and the other characters look at each other and say "What was all that about?" - after a little thought the earthy Masetto opines that it's time for his dinner...

Driving home I realise that this is all more like Quentin Tarantino's From Dusk to Dawn (1996) where a modern and grounded tale of crime and murder with no hint of the supernatural ends in a nightclub full of vampiric demons. But that film is even more amoral than the opera because the lead villain (George Clooney) survives rich and free whereas the decent pastor (Harvey Keitel) whom he had kidnapped is hideously butchered. Very similar humour though.

Incidentally the teenagers (who I naively thought might have found the film disturbing) thought the the supernatural stuff in Ghost a huge hoot just as I'm sure Mozart's audience did in 18C Prague when the opera premiered.

Lush

2011-09-21T16:53:00.020+01:00

The "Taking the Wheel" microbus and simulator rolled into Aberavon today on their penultimate county visit - last one in Swansea next week.

Service users and carers from Neath Port Talbot discuss the campaign’s theme of empowerment during the event and one service user tells us that living with bipolar disorder put a huge strain on her family life and personal relationships but her situation has improved hugely in recent years.

She says: "Having attended Hafal for the last seven years, I now feel completely in control of my own life.

"I have sorted out my finances, enrolled in college to do a counselling course, and have built up a good social life. Having previously suffered from agoraphobia my mental and physical health have never been better."

More good evidence that recovery is about life choices not just medicine!

See more about the campaign here.

Postscript:

This morning I shower in the gym and try out a new soap from Lush with citrus notes called "Sexy Peel" (i.e. "sex appeal", geddit?). I beg you to believe that this was not a symptom of mid life crisis but rather just another joyful experiment in male grooming. Anyway, in case anybody thinks this product might indeed make you more "ap-peel-ing" I can testify that it simply makes you smell of marmalade.

Unconflicted

2011-09-14T15:30:00.016+01:00

The "Taking the Wheel" microbus reached Abergavenny today where Jane, a service user and carer in her mid fifties who looks after her daughter (who has schizophrenia) and her housebound husband, says:

"Hafal has helped me take the wheel by encouraging and supporting me to do many things for myself which I wouldn’t have believed possible previously.

"For example where once I would have flown off the handle if I had a letter demanding rent from the council’s housing department I’ve learnt to approach tasks like this in a much calmer fashion. I file my letters away and do things like finances step-by-step.

"I used to rely on people and lean on services too much, now I will take the initiative myself and address these problems on my own."

Nice one, Jane, and good luck to all our friends in Monmouthshire working for recovery.

Postscript:

I have drawn South Africa in the office Rugby World Cup sweepstake so I have a half decent chance of repeating my success in the Grand National (see here) although Matt in Publications has drawn New Zealand so the drinks will probably be on him. Deputy Chief Exec Alun Thomas has Wales so he can feel patriotic and unconflicted but he's not making plans to spend his winnings just yet. But at least he didn't get Russia like poor Gavin Williams - I didn't even know they played the game...

Sick as a Parrot

2011-09-11T19:36:00.012+01:00

This weekend has been a game of two halves. On Saturday we go to Aberaeron and the elegant 18C bijou gentleman's residence of Llanerchaeron, an early work of London Welshman John Nash who went on to become the pre-eminent architect of the Regency not least as the creator of the Brighton Pavilion. Lovely kitchen gardens where we scrump some juicy plums for lunch and somehow I am attracted to the utilitarian brown linoleum below stairs.

Why do I - and many other people of my acquaintance - not like the National Trust? Could it be the plastic cow in Llanerchaeron's old dairy or is it their hypocrisy in opposing relaxation of planning regulations while themselves developing fancy housing for profit on ancient estates like Erddig near Wrexham in the teeth of local opposition?

On Sunday it's all sport, mine and other peoples'. Running early morning in the gym I see highlights of Swansea City's match the day before on Match of the Day. Their goalie Michel Vorm looks sick as a parrot after letting Arsène Wenger's embattled Gunners off the hook by bungling a clearance which every Swans fan from Sketty to St Thomas is confident they would not have bungled.

A little later I am in the biggest pub in Wind Street watching the Rugby World Cup over a cup of tea (it's still only 9.30 am). Hafal Senior Employment Officer Andrew Mulholland's £20 bet at 80/1 on Wales to win the tournament starts to look well-judged as we outplay and are ahead of the current champions South Africa...until the closing minutes when the Boks go one point ahead and then Wales bungles both a penalty and drop-goal opportunity. Robbed!

Postscript:

My own rugby career peaked early and went rapidly downhill. I played for my school first fifteen aged 12, for my house at my next school aged 17, and for my college's third fifteen aged 19 - and never since for shame. As a callow youth I showed some promise because I was both fast for my size and also unusually aggressive. I mainly played wing-forward (I'd never heard the word "flanker"), a great position in the low-grade game as the scrum-half frequently fumbles the ball and so you can descend sadistically upon him - and of course he's generally much smaller than you. Happy days.

A Second Chance at Life

2011-09-09T16:19:00.008+01:00

The microbus brought the "Taking the Wheel" campaign to Bridgend today where Doreen Shields tells us that managing her recovery through writing her own care plan has been an empowering experience:

"If you haven’t worked for a long time and you have a mental illness it’s hard to know what the first step to take is. It can seem like you’re written off. I was desperate to get back to work so I could get my life back into a routine.

"When it comes to writing a care plan it’s OK writing things down but in your mind you think: ‘I can’t possibly do that!’ but before you know it you have a review of your goals and you can see the progress you’ve made.

"My initial steps were: enroll in an IT course, do the IT course and pass it. I did that and now I’ve moved on to my second course in IT.

"The next step was to do volunteering work and since making that goal I’ve started doing some mentoring work at the local hospital.

"I’ve never felt judged during my training and now, six months since beginning the programme, I feel really motivated. My short-term goal is to do more courses to improve my CV, in the long-term I’d like to do some work in health and social care.

"When I came here I used to walk in with my head down, now my kids say to me: ‘What have you been doing?’ They notice the change. It sounds like a cliché but I feel like I’ve had a second chance at life."

Not a cliché, Doreen, but an inspirational story of courage and determination!

Read more about the campaign here.

Monmouthshire next on September 14th...

Chancers

2011-09-08T15:20:00.014+01:00

Having been rude about the word "collaborative" last week (see here) this week I attend a rather useful group meeting at the Swalec Stadium known as the Adult Mental Health Leaders Collaborative which brings together, as the name suggests, senior people in the NHS and local government plus key officials in the Welsh Government and some voluntary sector chancers like me.

This is an interesting networking opportunity and I renew acquaintances in what I realise is really quite a small world - the minority who are in management among people working in the narrow field of mental health in the small country that is Wales. It makes me realise that the very high recorded hits on our websites Hafal and Mental Health Wales are getting to a high proportion of the people we need to engage with. Though not competing remotely with those professional offerings even this wretched Blog has 1,000 visits a month by 400 people regularly looking in though admittedly that includes my mum as well as, one hopes, the great and good in Welsh mental health services.

Back to the Collaborative where Welsh Government officials spell out their intention to draft a new or perhaps reiterated mental health strategy for Wales. It sounds promising to me, having a clear focus on individuals achieving recovery through the Care and Treatment Plans required under Part 2 of the Mental Health Measure (though there is concern in the audience that the new strategy may be rushed).

But we will have to work hard to make this a reality, in particular ensuring that in future services are planned and financed as a response to individual patients' Plans rather than the other way round...

Autumnal

2011-09-04T11:42:00.014+01:00

Beautiful weather today but my autumnal pictures were taken before the sun burnt off the dawn mist. I've taken to walking out early with a tiny radio and this morning's news kicks off the new political season with three startling stories.

Alastair Darling's revelations about trench warfare in Downing Street in the dying days of the last UK government is trumped by the serious project announced last night to disband the Scottish Conservative Party; this in turn looks a small thing compared with the news that British intelligence services exchanged Christmas presents (and possibly prisoners) with Gadaffi's torturers and sadists.

These are troubling times but I reflect that it doesn't do to dwell too much on these matters. Over the weekend I read Hesketh Pearson's "Lives of the Wits" (1962) in which I learn that Jonathan Swift became so enraged by corrupt politics and injustice that it literally drove him to insanity; and Dr Johnson, arguably Swift's successor as the most humane voice of his time, said: "I'd as soon have a man break my bones as talk to me of public affairs, internal or external". Both men not only talked the talk but also impoverished themselves through tireless support of the poor and oppressed.

Dog's Breakfast

2011-09-02T12:16:00.013+01:00

Unsurprising news from the Welsh Government that they want something short of full reorganisation of local government, meaning that the 22 Councils stay but they should form six collaboratives in order to manage education and (important to mental health) social care. More here.

In spite of my rude headline I am quite sympathetic to the Government which has to deal with what's there now. Everybody agrees that the present system is completely unworkable (like the old NHS set-up with 22 LHBs - you have to pinch yourself to believe we had such a system) but if you change it then it'll cost a lot and everybody stops delivering while the musical chairs game is played out over two or three years...at which point it becomes clear that we still haven't got it right...

As an aside it should be pointed out that unlike the NHS botch this local government system wasn't the fault of a devolved government but rather of the UK Government in 1996. But it's there.

Hafal, always coming from a vigorous consumer position on such matters, was vocal from an early stage about the NHS structure - indeed we opposed its establishment all those years ago correctly predicting that it would prove inefficient if not unworkable. How little pleasure we took in being right!

I'm not sure whether Hafal will take a position on this quasi-reorganisation but for my part I would offer an alternative based on our experience that consumers of health and social services are (i) not interested in local politicians determining how such services should be delivered differently in their area (indeed they prefer uniform and consistent services across Wales) and (ii) have no strong feelings that health and social care should be provided by separate organisations (indeed they are driven to distraction trying to deal with two separate organisations).

On that basis my suggestion would be to keep the present councils but restrict their work to something like the old pre-1996 district councils' function; not my bag but perhaps run education on an all Wales basis but devolving wherever possible to local schools where these show competence; fully merge health and social services along the new LHB lines; and stop paying councillors other than expenses and return to a voluntarist approach to local government.

We are constantly being told that certain "accepted" things can no longer be afforded. I wonder if it is affordable (or was ever justified or supported by the public) to pay politicians below the all-Wales level in a country of just three million (half the population of Yorkshire)?

Postscript:

This word "collaborative", often these days transmuted into a noun, is getting used a lot. No doubt some "collaboratives" are a great idea but we should always be suspicious of institutions which defensively describe themselves in ways you can't easily disagree with - who can argue against setting up something "collaborative"?

Although on reflection it might be refreshing to set up an "uncollaborative" which worried less about talking and negotiating internally but instead got on with the job.

Go West

2011-09-01T13:06:00.010+01:00

The microbus went to the far west yesterday to park in the centre of Tenby and spread the message of mental health service-users taking control of their recovery.

Service User Lynn Hudson, 55, who has bipolar disorder, said: "I have been unwell since I was 18. I have had a difficult life and struggled in an abusive relationship for years.

"Since coming to TRI I have been empowered through friendship, care and support and can at last say that I am recovering. I enjoy writing children's stories and painting: my ambition is to be a published children's author.

"I'm receiving support from Hafal to realise my talents and enjoy my hobbies. I take part in workshops and courses at TRI and am now writing children's stories for my grandchildren. I hope that one day they will become a published piece of work.

"Events like 'Taking the Wheel' give Hafal members like myself an opportunity to display our work and have a real sense of pride. I know I haven't completely recovered; I know it will take a long time; but with the continued support from staff, volunteers and friends at TRI I know I will reach my goal."

Thanks, Lynn, and good luck to all our friends in Pembrokeshire who, as usual, have been tireless in backing this important campaign to empower service-users to:

- Take the driving seat in managing their own recovery from mental illness

- Make use of their new rights under the Mental Health Measure

- Make choices about the care and treatment they receive – and who provides them

- Develop and manage services themselves

- Engage with the providers of mental health services so that they can get more involved in planning and commissioning those services

You can read more about the campaign here.

Tacitus

2011-08-30T08:01:00.020+01:00

An interesting weekend in Bristol. While shopping in the city centre at Primark (which resides in the old House of Fraser building - how times have changed) I notice on my street map that I am only a few hundred yards from Stokes Croft, scene of riots both in May (connected to a Police crack-down on local anti-Tesco activities) and again in the recent "national" disturbances - so I wander up to take a look.

There isn't much sign of the damage now but the general environment is a real eye-opener. Not that it is unfamiliar. It's like going in a time machine back thirty years to run-down city centre communities in the 1980s. Ramshackle pubs, mouldering shops, overt signs of the vice industry, and (above all) relentless graffiti, posters and other imagery proclaiming what used to be called the "counterculture" - anti-police, nihilist/anarchist, and celebrating drugs.

It is especially depressing to see the same old gallows humour about the effects of drugs, which I would have associated with LSD but apparently works for its modern pharmaceutical successors, reminiscent of Robert Crumb's cartoons dating right back to the 1960s.

There's nothing new about all this which suggests that the riots reflect the same self-destructive behaviour which characterised the old counterculture. And I'm not at all persuaded that this behaviour has anything to do with imitation of black culture (note, Professor Starkey) but it is in fact a curious but very stale product of (wait for it) rather middle class preoccupations espoused by students from 1968 onwards. For example, the attack on Tesco appears to be based on the premise that we should all reject modern "agri-business" and buy our food at vast expense from rosy-cheeked peasants in the Farmers Market.

But I guess I should be pleased to see one bit of anarchist graffiti quoting Roman historian Tacitus in the original Latin: corruptisima republica plurimae leges (the more corrupt the state, the more numerous the laws).

So who is to blame? Aside from the looters themselves the greatest indictment must be of the local authority in Bristol which has lavished funds on fancy city-centre schemes for a whole generation but appears to wholly neglect a community living immediately adjacent to it. It beggars belief that while prosperity has transformed communities for so many years there remain these pockets of squalor.

Postscript:

And what of the Tesco Metro store, subject of so much trouble? It's open again and the ordinary people of Stokes Croft are quietly using it to buy safe, cheap, and mostly home-grown bread, milk, chicken, etc, products of the amazing industrialisation of UK agriculture which began 70 years ago as a response to a blockade by submarines and means today that we are virtually self-sufficient in food.

Meaningful

2011-08-26T17:46:00.003+01:00

Yesterday I drove up the A40 towards Brecon and turn right over the Beacons to arrive a bit late (I blame Dutch tourists slowing down to admire the mountains - it must look spectacular if you live on a great flat fen below sea level) at the "Taking the Wheel" campaign event in Merthyr Tydfil.

Sharon Harris, Hafal Expert Patient Trainer based in Merthyr, tells me:

"Choice of treatments is really important but it’s got to be meaningful. I had a choice of three types of non-medical treatments. I have used CBT, 'talk therapy' and a computer-based therapy. However, the problem was they were all time-limited and didn’t continue long enough to achieve a real effect in helping me recover. What’s needed is consistent, continuing support which lasts as long as you need to achieve real recovery."

See Hafal's "Treatments for Severe Mental Illness - A Practical Guide" here.

Shocking 90%

2011-08-23T16:34:00.010+01:00

A report published today by the think tank Demos (look here) makes much of its discovery that about 10% of suicides are of people who have terminal or serious, chronic physical illnesses.

We should have great concern for people who contemplate taking their lives when in that sort of physical condition. Their reasons for taking their lives will vary from a rational conclusion that their physical difficulties mean that life doesn't feel worth living through to less rational impulses arising from depression and despair.

The law should not prevent a rational person from taking their own life but it should not in my view permit others to assist them because, for all that we can all think of a few examples where this causes hardship, there would be much greater risk to many more people if we compromised the principle of protecting life. The great majority of doctors agree even though they of course see and understand the suffering of people with serious physical problems.

But the real story of these statistics is that a shocking 90% of people who take their own lives don't have a terminal or serious, chronic physical illness. Surely in a better world it would be just a small proportion?

Wiggly Vorm

2011-08-22T08:28:00.002+01:00

The Towy yesterday afternoon only five hundred yards from riot-torn streets

Well, it was only a matter of time. The riots and antisocial behaviour, manifestations of the "broken society", finally came to my street over the weekend. At least we had warning - the local agricultural show is always on the third Saturday of August and so I had removed my car into a back street and awaited the worst.

Sadly the worst was in evidence the next morning. The flower pot outside my house supplied by the Town Council had like last year been turned over. As I scraped the earth back into the pot and replanted the petunias two thoughts occur to me...

First, as the victim of this heinous horticultural crime for a moment I feel that no punishment would be too harsh for the perpetrator; for those few seconds I scoff at my own bleeding heart liberal views. This of course is why you need a dispassionate judicial system to hand down proportionate penalties unsullied by political considerations, something which some politicians have forgotten in recent days.

Second, I guess we should be grateful that the young farmers of West Wales confine their annual riot to some loud noise into the early hours plus broken beer glasses and a patchwork of vomit pools visible around the town the next morning. Fortunately they do not seem to have subscribed yet to the "gangsta" culture of guns and drugs which David Starkey has been provocatively pointing towards - just as well as most of them have shot-gun certificates!

Postscript:

Mrs Blog is appalled to find me up early again on Sunday watching Match of the Day. In vain I attempt to convey the drama of the Swans draw against Wigan and especially goal-keeper Michel Vorm's penalty save. He cost Swansea £1.5 million - apparently money well-spent. Quite a contrast to the soccer I used to play when we always put one of the fatter, more immobile boys in goal in the vain hope that he would physically block more of the goal and anyway would take all the blame when his defences were inevitably breached.

Seventy-Six Trombones

2011-08-18T14:17:00.010+01:00

The "Taking the Wheel" campaign rolled into my old stamping ground of Aberdare today to be greeted by a good crowd.

Nigel, a service user from Rhondda Cynon Taf who has schizophrenia, tells us:

"I am 51 years old and have lived with a diagnosis of schizophrenia for the past 25 years. I have been attending Hafal’s local service for the past six months - my first experience of such services - and the biggest benefit to myself and family has been a real raised level of self-esteem. I was stuck in a rut, but now I feel well supported by the staff and other users within the project.

"I take part in all project activities and have recently completed a basic IT course. I really enjoy the woodworking course, too, as this has given me a great opportunity to relearn old skills."

Hafal has been funded by the Big Lottery Mental Health Matters programme to help people with serious mental illness back to work through our Short Steps initiative. We do this by supporting them through training and education, helping them to achieve the qualifications they need. Hafal also works with employers, helping them to understand their role in ensuring that the mental health of all staff is well-managed.

For more information on Hafal’s Short Steps employment project look here.

Postscript:

I moved from Carmarthen to Cwmbach, Aberdare, in the 1980s and have fond memories of the local Allotment Society (membership number 76 - when I got my card the treasurer said I should remember it because of the song "Seventy-Six Trombones"), some respectable and many not-so-respectable public houses, the excellent amateur productions in the theatres in Aberdare and Aberaman, and above all the chippy in Whitcombe Street where the nice Welsh-Italian lady would discreetly slip me an extra piece of fish free of charge.

Hold The Front Page!

2011-08-16T10:27:00.003+01:00

Research by the Institute of Psychiatry, Kings College London, has suggested that childhood abuse doubles the risk of adults developing multiple and long-lasting episodes of depression (see more here).

"And we can also exclusively reveal that the Pope is a Catholic" I hear you say but in fairness the detail of the study is useful.

Researchers reviewed 16 studies, on a total of more than 23,000 patients, and found that maltreatment in childhood - such as rejection by mothers, harsh physical treatment or sexual abuse - significantly increased the risk of depression in later life.

The research, which was published in the American Journal of Psychiatry, also suggested that patients who received abuse as a child are less likely to respond to treatment. Well, again, it isn't surprising that people who face difficulty as children have more intractable mental health problems in adulthood.

We need to recognise that when adults have problems arising from difficult childhoods it will often not be sufficient to offer them relatively superficial talking therapies such as Cognitive Behavioural Therapy (CBT) which is best suited to relieving current symptoms or dishabituating patients from unhealthy or damaging behaviour. Rather patients will typically need in-depth counselling or psychotherapy which allows them to identify and come to terms with their problems.

We should resist a simplistic, one-size-fits-all approach to talking therapies and instead realise that there needs to be a range of therapies which can be applied appropriately to different problems and also offer choice to patients.

And, above all, we need to challenge the pernicious and widespread prejudice, shared both by many mental health professionals and inadvertently by "progressive" mental health campaigners, that talking therapies are mainly for low-level mental health problems and somehow unsuited to serious mental illness.

See Hafal's comprehensive guide to talking and medical treatments, which distinguishes clearly between the different types of psychological therapies, here.

Jack Army

2011-08-14T17:15:00.006+01:00

Alun Thomas' house (possibly)

Sunday lunch at my brother's place and I explain that while not much interested in soccer I can't help but be drawn to the drama that is Swansea City's miraculous elevation to the Premier League and their challenge to survive up there in the imminent new season. Their first match is tomorrow against mega-rich and strongly-tipped Manchester City (second favourite to their neighbour Man United).

Hafal Deputy Chief Executive and loyal season-ticket-holding City stalwart Alun Thomas (if I didn't know better I would supect that his constant jabbing away at his Blackberry was evidence of some sinister marshalling of the "Jack Army") has explained to me that it is incredibly hard to stay up in the Premiership because its world-class teams are way, way out in front of the Championship clubs (what used to be the second division I suppose) by reason of the vast resources they can expend for the best players.

As if to illustrate the problem I see on Match of the Day this morning that fellow newcomers QPR, after a few minutes of high hopes and a credible shot at goal, are ground down systematically 4 - 0 by old hands Bolton in their opening game. Ouch.

Postscript

My sister-in-law reveals that the response of my tiny niece to a new child-proof gate in the house (you know, the thing to stop infants venturing into dangerous areas like the stairs) was to grab a spoon and clatter it back and forth against the bars like James Cagney protesting in chokey. A rebel streak for sure.

After Puritanism

2011-08-12T13:55:00.001+01:00

I've just been rereading "After Puritanism" (1929), a collection of long essays by largely-forgotten journalist and writer Hugh Kingsmill (1889 – 1949). As I write this post I'm amazed to find it's been reprinted by Faber - see here.

In one essay he describes the transformation of the British view of children which took place either side of about 1850 from a Puritan one (in the correct meaning of the word) to a romantic, Victorian one.

Essentially the Puritan view is that we are born wild and wicked and so can only become civilised through good parenting and education; the romantic, Victorian view is that we are born sweet and innocent and only become wild and wicked through bad parenting and education.

The recent disturbances in UK cities (which the BBC is now calling the English disturbances though frankly any complacency in Wales about these matters would be very unwise) have brought out the usual moralising, snorting and deluded nostalgia for an earlier, more disciplined era, mainly articulated by politicians and journalists neither of whom have a very good recent record of moral probity.

But it is more interesting that, when you examine it carefully, the current commentary on the behaviour of young people is still firmly wedded to the romantic, Victorian notion of childhood - sweet little kiddies corrupted by evil influences including criminal parents, gang leaders, etc. There seems little sign after 160 years of any swing back to the Puritan idea that simple inattention by parents and others will lead young people into serious trouble because that is their natural inclination if unchecked.

Have we forgotten our own childhoods? I don't recall any evil influences in mine but I'm pretty sure I would have become seriously out of order if left to my own devices.

Of course we should crack down on any criminality by children and adults alike but paying closer attention, using mentoring and similar services to provide the necessary moral steering where parents are failing to do that, would go a long way towards reducing crime (and, indeed, mental health problems) among young people.

A sugar-coated, sentimental view of childhood inherited from the Victorians combined with self-righteous fury that it could be so corrupted by external influences isn't helping us to find solutions.

Information Hub

2011-08-10T12:55:00.002+01:00

Hafal's campaigning microbus has finished her North Wales leg and is back down here making an unscheduled stop at Cardiff Council's event at the Jasmine Centre yesterday and bringing the "Taking the Wheel" message to a large and enthusiastic crowd at Bargoed Community Centre today.

Bryn Davies, 24, began attending Hafal and engaging in activities six months ago. He tells us: "The activities Hafal have to offer have really helped with my anxiety and depression. I play guitar and have really enjoyed becoming involved in Hafal’s music group. We’ve performed to the local arts group and it’s helped me build my confidence up. I used to be in a band but when I became unwell I lost interest in it; however, the social aspect the music group has got has built up my esteem. I’m back into what I love doing.

"I have had a lot of help from my support worker and staff from Hafal. I have begun to move forward in my life. I’ve spoken about my illness to students at the local university; in the future I would like to help others, particularly young people, to engage in the activities that Hafal has got to offer".

This seems a good opportunity to mention our Big Lottery-funded Young People’s Information Hub which caters for the information needs of young people aged 11-25. The Hub’s website (look here), which gives tips on how to move forward on the road to recovery, was developed using the expertise of young Hafal Members with direct experience of serious mental illness.

Postscript

Q "What's the difference between ignorance and indolence?"

A "I don't know and I don't care".

Getting to Know the Minister

2011-08-08T17:00:00.001+01:00

Hafal Service User and Expert Patient Trainer Ian Baynes discusses his Care and Treatment Plan with Health and Social Services Minister Lesley Griffiths AM

Time for a round-up of Hafal's contact with the Minister for Health and Social Services, Lesley Griffiths AM, over the last ten days...

On Friday July 29th the Minister launched "Safeguarding for the protection of vulnerable adults", an educational DVD made by Hafal mental health service users and carers in conjunction with Wrexham County Borough Council and the Social Services Improvement Agency. Launching the DVD the Minister said: "This DVD is a very clear way for service users, carers and lay people to understand the concept of adult safeguarding and the need to promote it. It might seem obvious that a DVD primarily aimed at the service user should include service users, but sadly that’s not always the case". In my slot I emphasised the need to protect resources for mental health services and I tried to make the case, learning from the experience of the DVD, for making much more use of the expertise of service-users, for example in ensuring that the Mental Health Measure is successfully implemented.

On Saturday July 30th the Minister took part in a valuable discussion at our Eisteddfod stand about listening to patients who use secondary mental health services across Wales, in particular concerning the central importance of care planning and the opportunity the Mental Health (Wales) Measure will offer next year. The Minister heard how important it is that service users not only get excellent Care and Treatment Plans but that all secondary mental health services should be geared towards delivering those plans in order to give services a consumer focus.

On Wednesday August 3rd Lesley revisited Hafal’s stand at the Eisteddfod. Service users from Wrexham showed her their own individual Care and Treatment Plans and explained how they have helped them. Service user Steven Roberts, 40, who has schizophrenia, was among a group who explained to Lesley how their Plans have helped them to take important steps on their road to recovery. Steven has recently moved into his own flat after a period in supported housing. He has also learnt skills which will enable him to begin leading a computer course shortly.

In case you haven't spotted it Hafal is very clear that the Measure is pretty much the only show in town. There isn't going to be a load of new cash in the near future so we've got to look at best use of resources. The Mental Health (Wales) Measure requires that from June 2012 (six months later than originally planned) all users of secondary mental health services will have a legal right to a Care and Treatment Plan. Hafal is campaigning to ensure that these Plans are holistic and genuinely owned by the user and that they are focused on taking manageable small steps towards recovery.

Hafal Members also believe that the new Care and Treatment Plans should form the central focus for planning and funding all secondary mental health services. Put another way the costs of all secondary mental health services, from a high secure bed costing over £250,000 to a tenancy support visit costing £25, need to be justified by reference to an individual's Care Plan. At present there isn't much sign that services see things that way and I firmly believe that the only people who can open their eyes are patients and their families.

Gestapo

2011-08-03T07:55:00.001+01:00

An energetic cast including Leslie Grantham and Richard Gibson (aka Dirty Den and Herr Flick of the Gestapo respectively) made the best of Peter Gordon's tiresome comedy thriller "Death by Fatal Murder".

I was annoyed to detect flagrant "false corpsing", that is when an actor pretends to corpse (i.e. break out of character uncontrollably to laugh at the play) in order to get laughs when the play itself isn't very funny, a cynical ploy which I'm afraid most of last night's Swansea Grand audience swallowed hook, line and sinker.

The news this morning reports that theatre attendances are at a record high, good for the industry but not necessarily a sign of optimism as this could equally signal Weimar-style fin de siècle exuberance. Or am I just a pessimist?

Minister Takes The Wheel

2011-08-02T13:23:00.023+01:00

Health and Social Services Minister Lesley Griffiths took the wheel on Saturday while visiting our stand at the National Eisteddfod. Hafal Chair Elin Jones and North Wales employment lead Janet Randles explained the purpose of our joint campaign (link here) with the Mental Health Foundation and MDF the Bipolar Organisation Cymru which supports patients to...

• Take the driving seat in managing their own recovery from mental illness

• Make use of their new rights under the Mental Health Measure

• Make choices about the care and treatment they receive – and who provides them

• Develop and manage services themselves

• Engage with the providers of mental health services so that they can get more involved in planning and commissioning those services

The Minister is getting increasingly familiar with us having attended the launch of the Safeguarding DVD the day before (see two posts back) and we are expecting to see her again at the Eisteddfod wearing her hat as the local AM. I'll pick up on the messages we are conveying to her - and to the Welsh Government generally - later in the week.

Meanwhile I attended the Eisteddfod on Monday and it is certainly in a pleasant setting, unlike last year when the Maes sat uncomfortably in a dusty shambles of industrial scrap. The traditional Eisteddfod soaking came of course and momentarily knocked out our leccie but this was swiftly restored and the simulator swung back into action.

My tour of the Maes yielded some useful reacquaintances plus two sturdy jute "bags for life" from the Welsh Government stand - evidently they have a guilty concience about their new plastic bag tax so they are giving these away to save you paying the tax.

Actually I am not hostile to the bag tax because unlike most of those pesky environmentalists' annoying ideas at least it won't punish poor people or stop us enjoying ourselves. It should in fact marginally reduce the cost of our shopping (so long as you bring your own bag along of course) because Tesco's and co won't have to supply as many bags.

As a bonus inside each bag I find a pedometer also with the Government's logo - so there's an almost useful public health message too about taking more exercise (see my encomium on these ingenious machines here).

As a loyal citizen of the new Wales I look forward to stepping out with my (Welsh) Government-issue, environmentally-friendly shopping bag, measuring my 10,000 steps on my Government-issue pedometer and thereby reducing my call on the Government-issue free prescriptions, though through greater longevity possibly increasing my future call on a Government-issue free bus pass. How did we ever manage before devolution?

Postscript:

In case you think I sound unsympathetic towards environmental matters please be assured that Hafal has a brilliant "Green Plan" specifying how we will save the planet. I look forward to reciprocation by Greenpeace and Friends of the Earth who I trust are putting the finishing touches to their comprehensive mental health action plans.

Irritable Bullocks

2011-07-31T19:59:00.027+01:00

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

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

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

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

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

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

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

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

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

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

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

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

Safeguarding

2011-07-29T10:04:00.005+01:00

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

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

Tug-of-War

2011-07-28T10:43:00.006+01:00

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

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

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

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

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

A Difficult Subject

2011-07-26T11:54:00.018+01:00

The Norwegian Church in Cardiff this week

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

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

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

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

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

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

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

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

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

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

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

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

Heroic

2011-07-24T17:25:00.011+01:00

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

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

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

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

Hafal Telly

2011-07-22T15:05:00.007+01:00

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

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

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

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

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

Barbarella

2011-07-20T11:19:00.009+01:00

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

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

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

21 Windows, 22 Counties

2011-07-20T09:14:00.003+01:00

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

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

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

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

The campaign, which runs until September, is engaging people receiving secondary mental health services or who have serious mental illnesses such as schizophrenia, bipolar disorder and other diagnoses which typically require high levels of care. Service-user led organisations Hafal and MDF the Bipolar Organisation Cymru are working in partnership with the Mental Health Foundation to support the campaign which will empower people with serious mental illness to:

- Take the driving seat in managing their own recovery from serious mental illness

- Make use of their new rights under the Mental Health (Wales) Measure

- Make choices about the care and treatment they receive - and who provides them

- Develop and manage services themselves

- Engage with the providers of mental health services so that they can get involved in planning and commissioning mental health services

A word from our partners...

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

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

Constantinople?

2011-07-17T07:31:00.016+01:00

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

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

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

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

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

Postscript:

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

Elegiac

2011-07-10T18:50:00.001+01:00

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

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

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

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

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

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

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

Postscript:

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

Fearsome

2011-07-08T14:37:00.012+01:00

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

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

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

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

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

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

See Hafal's advice for carers here.

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

Defiance

2011-07-07T13:16:00.002+01:00

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

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

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

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

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

Could Do Better

2011-07-07T08:02:00.015+01:00

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

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

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

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

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

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

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

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

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

Slippery Freudian

2011-07-03T17:25:00.009+01:00

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

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

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

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

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

Chilled

2011-06-29T06:18:00.007+01:00

I must admit I am so chilled on my holiday that I only caught up this morning with news of the "Taking the Wheel" campaign which reached Denbigh Town Hall yesterday.

Hafal Practice Leader Caroline Jones reports: "We've had a good discussion on how people with serious mental illness can take control of their lives."

Speaking on what empowered her, service user and carer Ann Edwards, 52, said: "Finding the right medication has been the greatest help for me.

"I had a breakdown when I was 24. Everything got on top of me, it was bewildering. However, it didn't take me long to find the right medication. There have been side-effects, it makes me put on weight, but I'd say my medication has been the main thing that's kept my schizophrenia under control, that's kept me balanced."

Ann cares for her husband, who also has a serious mental illness. She says attending carers' meetings has helped her manage her caring duties and her own recovery.

She said: "Going to meetings helps me a lot. I've made a few friends and found that sharing my thoughts with others makes me feel less alone.

"I get stressed at times, sometimes I have a little cry, but I've learned to manage my illness myself. I make the decisions about my recovery. I sort out a lot of things for my partner and me, we work together."

Caroline says that while it is crucial that clients are involved in choosing the right medication "this is only part of Hafal's broad ‘Whole Person' approach to recovery which encourages our clients to look at a variety of areas in their life including issues like accommodation, finance, training and education."

Quite so, Caroline, and you can see our recovery guide here.

Now I am off for another scramble around the coast (smothered in sun-block having turned beetroot in yesterday's uninterrupted sunshine) followed by more fishing. Will the elusive bass fall to my running ledger cast at low water beyond the tidal zone? Almost certainly not but hey-ho.

Noisy Clown

2011-06-28T17:53:00.013+01:00

I'm on holiday (my mate Nick says it's pretentious and self-important to say you're "on leave" and I think he's right) and today I achieved a dubious variation on the triathlon concept - a 9 mile walk, 4 mile cycle ride, and 50 yard swim. The last bit was unimpressive not by reason of the cumulative physical strain but because the temperature is somewhere between "Titanic" and "The Cruel Sea". You can just see me in the picture framed by two tankers waiting to get into Milford Haven. I brought my shorty wet-suit (Asda £12.99) to the beach but don't wear it as it's a bit wussy to cheat unless you are snorkeling or similar.

I have also polished my Ray Mears credentials by finding a big specimen of parasol mushroom (macrolepiota procera) which we enjoyed for breakfast. It's great just fried in butter but our Mitteleuropäischer cousins (especially the Bohemians) like to dip it in egg and breadcrumbs first and make an excellent veggie schnitzel (usual warning - don't pick unusual mushrooms without expert advice unless you are yourself an expert: mistakes can be fatal).

Postscript:

The idea of Central Europeans as cousins is topical. We heard earlier in the week that geneticists have established that English people are closely related to the Germans. This was hardly a surprise as everybody knows that England was run, with a bit of help from the Romans, by the Welsh (then called Ancient Brits) until the Germans (then called Angles and Saxons) arrived and pushed them back to the fringes. But the Sun newspaper is agitated about this news and has provided practical self-testing tools for worried English people to check their propensity for humourlessness, leather shorts, beach-towel crimes, megalomaniacal bids for world domination, etc. But Sun readers will no doubt reflect carefully and appreciate that they are as much the cousins of Handel, Goethe and Frederick the Great as they are of that noisy clown Richard Wagner, wicked supremacist Oswald Spengler, and, yes, him. We can all choose which of our relations we should emulate.

More Pollacks

2011-06-27T17:48:00.012+01:00

It's my birthday and I spend it fishing with my brother in West Wales at a favourite "mark" which involves a difficult climb down a cliff on a promontory overlooking St Brides Bay (my picture shows the view higher up looking west to the scattering of rocks south of Ramsey Island). But the reward is being able to cast into deep water and so increase the chance of good size fish - pollack, mackerel, disappointing wrasse or highly-prized bass - especially in not so good weather and modest tides, both conditions applying today.

We find an elderly lady already down there using sand-eel under a float. She explains that she is a widow whose husband on his death-bed earnestly begged her to promise him not to climb down this very cliff after he was gone, an understandable request as it is a dangerous spot. But she was clear at that time that she would climb the cliff in future to fish. So I said "Did you tell him a white lie to put him at his ease?" She was surprised by this and said that on the contrary she told him she could not make the promise. On reflection I think she made the right ethical call on this. It is a mistake to over-indulge people nearing death about matters in the future. She may have given her husband a little anxiety but I dare say he respected her honesty. And of course she could go ahead and take the risk of climbing the cliff in future (as she had for some years) without a qualm.

Feathers don't work so I try a rag-worm 5 feet under a float. Nothing happens when I cast it 30 yards and leave it for 15 minutes but when I reel it in it is grabbed violently when it is just a few feet from the rocks. The rod bends double when I strike and a huge pollack is landed with some difficulty, sufficient for my and Mrs B's dinner. That's all we catch but the old lady very kindly gives us two pollack which my brother takes home for his dinner.

Môn Mam Cymru

2011-06-22T14:47:00.022+01:00

Hafal's intrepid microbus crossed the water courtesy of Thomas Telford to Wales' premier island bringing the “Taking the Wheel” campaign to Holyhead where service users and carers have been discussing the campaign’s theme of empowerment during today’s event.

Hafal's family worker Cathrin Jones (pictured above with some of the state-of-the-art touch-screen technology with which the vintage van is rammed) reports:

“We’ve had a good discussion on how people with serious mental illness can take control of their lives today.

“One factor often neglected is that users have their own caring or parenting responsibilities. For example among the service users we support on the island there are people who as well as dealing with their own mental illness have partners with physical disabilities.

“Users' own caring responsibilities are covered as one of the eight life areas in the Mental Health (Wales) Measure and we certainly hope it’s something that is included in the new Care and Treatment Plans which come into force when the Measure is implemented on January 1st 2012.

“Unfortunately, this issue has often been neglected in the past as there is a tendency to concentrate on immediate symptoms of service users’ illness rather than also looking at their wider life including their responsibilities for others.”

Good point. We await publication of the Measure's Regulations following the recent consultation - we fear that there won't be consistent planning for patients' responsibilities as mums or dads or other caring duties unless there's a specific place in the Care and Treatment Plan format to record it in (or to confirm that they don't have any such responsibilities for the time being)...

Giraldus Cambrensis called Ynys Môn the "Mother of Wales" because of her alleged capacity to feed the country. He couldn't have predicted that she would also be able to heat and light much of Wales with her two Wylfa nuclear reactors pumping out nearly one billion watts (output which might more than double if they replace the reactors).

"Non-Compliant"?

2011-06-22T12:28:00.005+01:00

I am contemplating the excellent feedback we had last week from a major training event on treatments for serious mental illness. We went into detail about both medical and talking therapies, assisted by our good friend and leading Welsh mental health pharmacist Wendy Davies from Cardiff and Vale LHB and the pioneering team of talking therapists from Hywel Dda LHB.

Discussion about antipsychotic and other mental health drugs has been clouded in ideological squabbling over the years, between the antipsychiatric "movement" on the one hand and over-defensive doctors on the other. Much of this debate has left out the people who matter - the patients and their families who aren't interested in philosophical hair-splitting about the nature of mental illness but who do want the best treatments available to aid recovery and improve the quality of their lives.

Information, negotiation, and being prepared to try things out are the way forward for patients who still often find it hard to get their own view heard let alone be offered choices.

I do think there is an important but neglected point which has been lost in the fog of controversy. Some patients (by no means all) tell us rationally enough that the side effects arising from their specific experience of antipsychotic medication for them outweigh benefits which they acknowledge (of course sometimes treatment just doesn't help but that's quite another matter) so that they want to discuss whether they might manage better without medication.

I do not detect much sympathy for this group of patients who are not behaving irrationally, still less trying to make an antipsychiatric point, but trying to achieve the best result for themselves. However, they are often labelled "non-compliant" and lumped together with patients who might indeed be failing to take their medication by reason of their mental illness.

Nobody is pretending that it is easy to distinguish rational and less rational reasons why patients form their opinions about medication but there should be much more effort put into talking therapies which directly address symptoms of serious mental illness or else assist people to adapt themselves to live successfully with their symptoms rather than take drugs which can severely debilitate them.

Is it not reasonable, for example, for some people who hear voices to wish to come to terms with that symptom and avoid using powerful and toxic drugs in an attempt to dampen down or remove those voices, if that works better for them? But where is the support for such an approach? Is it considered seriously as an option?

Of course this isn't going to work for everybody and may indeed only be a serious option for a minority of those with psychotic symptoms, at least on the basis of current knowledge (whereas the use of medication for lower level mental health problems could and should be drastically reduced). Our strong advice is that patients do not stop taking or reduce their medication without discussing the issues with their doctor. But there is no harm in asking, especially if you are having a lot of problems with side-effects (and, anyway, a different drug might improve matters).

For Hafal's comprehensive guide to treatments for severe mental illness, both medical and psychological, see here.

Inexplicable

2011-06-20T08:55:00.015+01:00

There is no simple explanation of why Shakespeare wrote such a nasty play as The Taming of the Shrew, a production of which by the Festival Players Theatre Company I saw yesterday in Dinefwr Park.

There is much good stuff in the play but you can't get away from the essentials of the plot which involves the bullying and abuse of a single-minded woman into submissive, blind obedience by her jocular and borderline psychopathic husband, apparently a satisfactory result for the playwright. People who don't know Shakespeare well might find this unsurprising, considering the play was written over 400 years ago, but in fact this is quite out of character for the open-minded WS who wrote good parts for women (well, men playing women) and clearly had no perception of them being in any way inferior.

Some people think that the Merchant of Venice is also a "problem play" because of the portrayal of Shylock but it has never seemed to me that the play is antisemitic - Shylock is indeed wicked but also all there as a human being. But there's no getting round the discomfort of this play.

In recent years many actresses have played Katherine's submissive speech at the end of the play with heavy irony, implying that she doesn't mean it but is somehow playing along for laughs or to avoid further abuse. But that is a bit desperate and hats off to this production for playing it straight and letting the audience judge for themselves.

Maybe the only explanation is that Shakespeare was crudely and unjustifiably expiating some fiercely held personal feelings (if so this was unusual because his work is frustratingly short on clues to his personality). Did he leave Stratford because he was bullied by Anne Hathaway? Or was there another woman he had taken up with in London who ran him around? Only the discovery of a cache of his private letters will tell us. I once shocked the Church Warden of Holy Trinity Church, Stratford, by suggesting that they dig him up and see what was buried with him, notwithstanding the curse he placed on his grave...

Good frend for Iesvs sake forbeare,
To digg the dvst encloased heare.
Bleste be ye man yt spares thes stones,
And cvrst be he yt moves my bones.

Every Little Helps

2011-06-15T13:24:00.012+01:00

The “Taking the Wheel” campaign microbus reached Ebbw Vale Tesco's today in the unseasonal rain but spirits were not dampened.

Hafal Practice Leader Pam Johnson said: “We’ve been particularly interested in looking at how service users can take control of their recovery by creating their own recovery plans – a key area in the Taking the Wheel campaign.

“Today staff and clients were talking about an exciting new development which means service users can gain qualifications accredited by Agored as part of their work in developing and implementing their own recovery plan."

Indeed they can - contact Irene Hogan at our Training Centre for details.

Interesting factoid: apparently Tesco takes 1 in every 9 pounds spent by shoppers (a figure I don't find hard to believe as they seem to get most of mine).

Time for a Haircut

2011-06-14T12:58:00.022+01:00

I like Hafal's Dave Smith's personal story about stigma which he tells us as the new Time to Change initiative is launched this week by Hafal and our partners Gofal and Mind Cymru (see the story and further details of the campaign here).

Dave, who is on the Time to Change Wales project board, says: "The story I always tell about stigma relates to one occasion when I got my hair cut. The hairdresser said: "Day off work?" I said: "Yes, I have every Monday off." She asked me what I did for a living: I told her I worked at a mental health project helping people to recover from serious mental illness. She said that was a good line of work to be in and asked: "What got you into that?" I told her that I had a mental illness myself and suddenly the speed of the scissors literally doubled! She couldn't get me out of the shop fast enough!"

The three mental health charities have joined forces to launch the new national programme which aims to challenge the stigma and discrimination surrounding mental illness. The campaign is funded by the Big Lottery, Comic Relief and the Welsh Government.

Dave explains further: "During the campaign there will be a strong emphasis on combating discrimination by giving the public the opportunity to hear the stories of people with lived experience of serious mental illness. The campaign will not be about criticising people for their lack of knowledge on mental health matters; it will be all about giving them good information and providing opportunities for understanding. There will be no finger-wagging."

Postscript:
Hair-dressing venues - male, female, or mixed - make an interesting reference point for measuring levels of discrimination. Throughout my youth the gents' barber shop in Ammanford provided me with valuable insights into prevailing attitudes as they changed in the 1970s. I well remember the first female barber being taken on and the large sign telling customers that they could wait for a male cutter if they preferred. I recall that the very young and very old were happy with the revolutionary concept of a woman cutting their hair but the middle-aged (people my age now I suppose) often took up the option to refuse (and it's a sure bet that sales of prophylactics dropped like a stone). I was fine with it though I recall some embarrassment as a teenager having my hair cut by a lady barber in late and evidently uncomfortable pregnancy - frankly an intimate experience and it was all she could do to reach across to my head with the electric clippers.

The "Smoke" and Mirrors

2011-06-13T21:33:00.009+01:00

An eventful and extravagant weekend in the "Smoke", "Great Wen", or whatever you choose to call England's venerable capital city.

On Saturday we celebrate Mrs Blog's birthday at Welsh-Italian chef-off-the-TV Angela Hartnett's Murano restaurant in Mayfair. We last went soon after it opened three years ago when Hartnett was still working under Gordon Ramsay but she is doing just as well independently. The £30 lunch is a best kept secret - not disastrously expensive and every mouthful exquisite and served by the most professional team. Best dish a ceviche (raw fish marinated in lemon juice) of bream - sensational (or "historic" as Michael Winner would put it).

After that we stroll up Piccadilly to see Noel Coward's Blithe Spirit at the Apollo Theatre with a celebrity cast including Alison Steadman, Hermione Norris, Robert Bathurst and Ruthie Henshall (who gets my Oscar playing the spiteful ghost of first wife Elvira). The production is fine - "workmanlike" is the word I'm looking for - but doesn't fully zing or quite bring out the subtle satire on the self-satisfied toffs which Coward intends. Nevertheless a memorable performance.

On Sunday we motor up from Farnham to the South Bank in order to board the "Golden Salamander", a panelled and mirrored old gin palace with two fine salons hired for the afternoon by my Mum to celebrate her birthday. 60 guests, family and friends from Wales, England and further afield, some of whom I haven't seen for many years, enjoy lunch and refreshments as the stately vessel glides easily down to Greenwich then fights the tide back up to the Festival Hall. The Thames is a grand river and this is a great way to see London in style.

Postscript:
The Great Wen (meaning "boil" or any source of corruption) is a coinage of soldier, MP, and defender of the rural poor William Cobbett (1763 - 1835) whose grave in St Andrew's, Farnham my brother and I inspect on Saturday evening. Cobbett, who served two years in prison for seditious journalism, distrusted paper money, bankers, and other financial speculators; and he blamed tea for weakening the nation because (Public Health officials please look away now) it had replaced beer as the breakfast beverage of choice for the British labourer. He also wrote excellent advice on gardening including this tip for killing slugs - fill a small cloth bag with lime, then walk up and down the garden after dark patting it vigorously so that a cloud of the powder descends on the ground. Any slug touched by the lime is a goner. This actually works. You really cannot afford not to read this Blog.

Quibbles and Nitpicking

2011-06-10T12:08:00.002+01:00

Take a look at the new Attitudes to Mental Illness - 2011 Survey Report. This makes interesting reading and, although the authors emphasise some positive changes, the change since 1994 is pretty slight and there are evidently a number of areas where there has been no positive change.

Also, am I being picky or does the report make some rather simplistic assumptions about what is a good or bad attitude to mental illness? For example, it is assumed that it is "good" to agree with the statement "Mental illness is an illness like any other". Of course we know what they are driving at but actually many reasonable people would not agree, believing that physical illnesses as a group share obvious characteristics not shared by mental illness. So how many people not agreeing are perfectly reasonable people without prejudice and not ignorant about the facts about mental illness?

And another one: it is assumed that you are out of touch, ignorant, or prejudiced if you don't agree with the statement "Mental hospitals are an outdated means of treating people with mental illness". Again you know what they are trying to get at but this is sloppily expressed because the most progressive approach to treatment would acknowledge the role of the right sort of mental hospital in the treament of some patients some of the time.

Looking at the statistics suggests to me that younger people may have refused to accept the "politically correct" but actually sloppy and simplistic statements not through prejudice but because they analysed the statements rather carefully. Anyway here are the suspect stats...

Notwithstanding my quibbles and nitpicking this is an important report and gives valuable insights into how we might influence attitudes and behaviour not through preachy condemnation but through information and, above all, promoting contact and discussion between the public and people affected by mental illness.

Diabolical

2011-06-09T09:45:00.024+01:00

There is much attention today on Justice Secretary Ken Clarke’s embattled position on sentencing reform. The Sun has him on their front page as a Teletubby living in Laa-Laa Land – ie out of touch with what (the Sun asserts) the public wants to be done to offenders. All this is overshadowing the closely-connected issue of women in prison and the report published this week by the Women’s Justice Taskforce. Allow me to rehearse some of what’s in that report...

Over the past 15 years the women’s prison population has risen from 1,800 to over 4,000 today – an increase of 114%. Most women serve short sentences for non-violent crime and for those serving sentences of less than 12 months, almost two thirds are re-convicted within a year of release. The average cost of a women’s prison place is £56,415 a year. By contrast, an intensive community order costs in the region of £10,000 - £15,000.

The Taskforce was established in 2010 to take a fresh look at an old problem this time focusing on the economics, structure and accountability of women’s justice. Its membership includes senior representatives from the Magistrates’ Association, the Association of Chief Police Officers, probation, prisons, women’s centres, politics, the media and former offenders.

The report makes clear that the current economic climate and the government’s proposed overhaul of the justice system provide a timely opportunity to look again at how women’s justice is delivered. The government's programme to reduce unnecessary imprisonment should be accelerated, and the money saved from the women’s prison estate reinvested to support effective services for female offenders in the community. Many of the solutions to women’s offending lie outside of the justice system in health, housing, and treatment for drug addiction and, of course, mental illness.

Women released from custody having served a sentence of less than 12 months are more likely to reoffend than those who received a community order; in 2008 the difference in proven reoffending rates was 8.3%. An estimated 17,700 children are separated from their mothers by imprisonment and only 5% of them remain in their own home while their mother is in custody.

However, while women’s prisons are funded centrally through the National Offender Management Service, women’s centres rely on a wide range of funding sources to enable them to supervise court orders and deliver services for vulnerable women in their area. The Taskforce heard evidence from the manager of one centre that was reliant on 37 different funding streams, with a mixture of statutory and non-statutory sources, all with different methods of evaluation and reporting arrangements.

There is a crying need to get serious about diversion based on good evidence of what works (and not what the Sun says), to close women’s prisons and to reinvest in mental health and other services.

Hafal’s Link Service has a specialist team assisting Welsh women prisoners in the two main prisons which take women from Wales, Eastwood Park and Styal. Our experience bears out what the Taskforce is saying. No amount of reform of the present system or good will from professionals will make prison an effective, humane, or cost-effective means to deal with the great majority of women prisoners of whom some 30% have a serious mental illness and far more have lesser but significant mental health problems.

I challenge anybody to name a greater, ongoing scandal in our society than the treatment by the state of those 30% of women and 10% of male prisoners with a serious mental illness. Britain’s prisons are anyway a matter for public shame as repeated reports by HM Inspector show. But that we knowingly place people so seriously ill and vulnerable within these dangerous and dysfunctional environments is diabolical.

See the Taskforce's report here and for details of Hafal's Criminal Justice Link Service go here.

Postscript:
If you disagree with me then my therapeutic advice is to deal with your punitive apoplexy by playing the Sun's "Lob a Hush Puppy at Ken Clarke" game here until you've got it out of your system and start to see reason...

Good Will, Flexibility and Patience

2011-06-08T15:40:00.003+01:00

Following her visit to Ceredigion last week the microbus has crossed the Teifi and thrashed her tiny air-cooled engine to arrive safely at Guildhall Square, Carmarthen today for my home county's "Taking the Wheel" event.

Hafal's lead in Carmarthenshire Jonathan Willey says: "A display of the work our project provides has taken pride of place at our event today. There's been plenty of refreshments and information on hand for visitors too. Those who've wished to test their knowledge of mental health have taken part in our mental health driving test quiz which has proved a lot of fun.

"Our popular campaign camper van and racing simulator have been on hand for visitors to view and enjoy; visitors have been able literally to ‘take the wheel' as they've raced in the simulator which has been exciting."

Clive Evans, 47, who has schizophrenia and attends the Hafal Ammanford Resource Centre talks eloquently about how he has taken the wheel: “Since moving to Ammanford two years ago my life has changed completely thanks to support from Hafal Ammanford, Sŵn y Gwynt Community Mental Health Team and friends.

“I feel that for the first time in my life people have listened to me and what I need. Hafal helped me put together a programme to make changes which led to me reducing my medication, joining a gym and learning how to use a computer. I feel I’ve come a long way in a few years. Hafal staff have provided me with the support to make positive changes to my life; I now have freedom to move on after many wasted years.”

Yesterday I bumped into colleagues from MDF the Bipolar Organisation and the Mental Health Foundation - our two partners in the Campaign - and we agreed the initiative is going really well. A quick reminder that the Campaign aims to support patients to...

- Take the driving seat in managing their own recovery from mental illness

- Make use of their new rights under the Mental Health Measure

- Make choices about the care and treatment they receive – and who provides them

- Develop and manage services themselves

- Engage with the providers of mental health services so that they can get more involved in planning and commissioning those services

Meanwhile a quick tribute to Andrew Macintosh, his two stalwart volunteers David and Morgan, and the other staff and volunteers keeping the bus on the road. As you can imagine the 22 local events plus two big shows present major challenges in organisation and staffing. Hafal doesn't have any fancy, dedicated display team so all this requires a lot of good will, flexibility and patience - not least when the 21st century car alarm system lets us down yet again while the 1960s German engineering carries on reliably!

Next stop Blaenau Gwent...

.

Watteau Jeeves

2011-06-05T08:09:00.016+01:00

What do you think of my newly acquired landscape? The frame is a bit wonky but otherwise a fine piece. It is not a French landscape picked up for 8m euros (the going rate for a Watteau) but was easily composed by me today using handy frames positioned by the National Trust which seems to have got a sense of humour at long last (see the step-back view below).

Equally quirky the Trust has installed "talking seats" one of which I tried out today. Some seats apparently have the voice of the definitive player of Jeeves (and campaigner against discrimination towards people with a mental illness) Stephen Fry but mine had that of the naturalist Iolo Williams who talked me through the scenery very personably. See the unlikely story of the seats here.

I also enjoyed an interesting take on the late 18C French political landscape (spot the forced link) in Trinity College Carmarthen's Scarlet Pimpernel with a particularly sinister Chauvelin (those "damned Frenchies'" wily head of covert operations) played by a woman. The Pimpernel also turned out to be female (the character not just the actor) in this version. And why not? The original author Baroness Orczy could scarcely complain that this deviation from her improbable plot stretched credulity any further.

Principalities

2011-06-03T20:05:00.002+01:00

Monte Carlo has nothing on this. Today's stage of the "Taking the Wheel" Welsh Rally finds the chrome on our 1964 VW microbus catching the intense sun-light as it glides around the scenic corniche overlooking Cardigan Bay and comes to a dignified halt on the sea-front in Aberystwyth.

Anna Bellingham, Hafal's Aberystwyth-based Training and Development Manager, says: "Our popular campaign camper van and racing simulator is on hand for visitors to view and enjoy; visitors are literally able literally to ‘take the wheel' as they race in a camper van rally simulator which is proving to be a lot of fun. There's plenty of information on serious mental illness available for people to take away, too."

Anna says the message from service users to come out of today's event is one that resonates throughout Wales, that is the lack of move-on accommodation for service users currently having 24-hour support."

Service-user led organisations Hafal and MDF the Bipolar Organisation Cymru have joined forces with the Mental Health Foundation to support the campaign which will empower people with serious mental illness to:

• Take the driving seat in managing their own recovery from serious mental illness.

• Make use of their new rights under the Mental Health (Wales) Measure.

• Make choices about the care and treatment they receive – and who provides them.

• Develop and manage services themselves.

• Engage with the providers of mental health services so that they can get involved in planning and commissioning those services.

Postscript:

Believe it or not the Prince of Monaco attended a St David's Day luncheon in Monte Carlo this March which was also graced by one of our Principality's respected royalty - I mean of course Dame Shirley Bassey. What the Prince made of the Welsh rabbit and cawl on the menu was not reported. Although, come to think about it, just as Aberystwyth on a sunny day looks very like Monte Carlo so too Monegasque cuisine is oddly familiar: Barbagiuan (a cheese'n'leek pastie - no really, I kid you not); Socca (a heavy pancake - what we call a crempog). At the risk of sounding disloyal I wonder if like us they go to France if they want something decent to eat.

As Flat As Any Flounder

2011-06-01T21:29:00.008+01:00

Still oppressed somewhat by minor health problems (now including gout in my big toe) I managed to get out on this last long weekend when my friend Nick comes to stay. I gave him some options and he rejects fishing in favour of visiting the Hay-on-Wye Literary Festival.

This was in general as annoying as last year (see this post) but the trip was made worthwhile by a lecture by Adam Nicolson about his book on the making of the King James or "Authorised" Bible in the early 17th Century. When God Spoke English makes intriguing reading as the largely forgotten committee which "project-managed" the translation comprised some surprising and far from puritanical characters.

For example, the poor old Dean of St Paul's, John Overall (who went to the same college as me and Nick though he must have worked harder than us we agree), had cleverly managed to woo and marry one Anne Orwell, reputedly the most gorgeous girl in the realm. But he was so busy translating the Bible that she strayed with a passing Yorkshire aristocrat. As the courtiers versed cruelly...

The Dean of St Paul's did search for his wife
And where d'ye think he found her?
Even upon Sir John Selby's bed,
As flat as any flounder

Nicolson also enlivens his talk by comparing the Bible project with the Millennium Dome fiasco which he had a part in as some kind of official historian. But as he admits the comparison breaks down in as much as, unlike the Bible, the Dome was a spectacular waste of time and money without any useful legacy.

Incidentally Nicolson, son of the writer Nigel Nicolson and grandson of the writers Vita Sackville-West and Sir Harold Nicolson, also wrote the excellent Sea Room about the remote and uninhabited Shiant Isles in the Hebrides.

Like last year I'm keen to get away from the self-congratulatory atmosphere at the Festival so we head off to the ruins of Llanthony Abbey, the Dissolution of which was a consequence of the Reformation just as it later brought about the creation of James's Bible. As a good Catholic Nick mourns the passing of this ancient priory but I unsympathetically point out that the ruins are picturesque and the old crypt is now a pub. So Henry VIII wasn't all wrong.

Postscript:

James I also had gout and the illness has traditionally been associated with privilege. However, although the highest incidence of this painful condition in the UK is in affluent Surrey the second highest is... Merthyr Tydfil. So I feel reasonably democratic in my mercifully mild suffering.

Ponty Party

2011-05-27T13:40:00.002+01:00

The “Taking the Wheel” campaign reached Pontypool yesterday.

Hafal's Torfaen Practice Leader Pam Johnson reports: "Our theme for the day was 'Looking after yourself physically'. We chose this theme because recovery from serious mental illness isn't just about medication or other therapies that deal directly with symptoms. These can be very important but mental health is built on much broader foundations and we wanted to emphasise the importance of physical health in relation to recovery."

Exercise and therapy sessions took place during the event and a buffet was provided. Carers, service users and key contacts in mental health services attended along with local school children.

Pam added: “Service users have been talking about the new legislation in Wales; they welcome the Mental Health Measure and hope that the new law will improve the quality of care plans.”

Pam also raised a priority concern in Torfaen: “Service users value the services which Hafal provides particularly the support we give families affected by serious mental illness. Clients would like our family support and advocacy service to be expanded as Hafal can only provide 10 hours a week at present due to lack of funding. This service has to cover the whole borough; to be honest it only scratches the surface at the moment." A useful reminder that bread and butter issues concerning essential local services need to be addressed.

NHS Cuts...and Opportunities

2011-05-25T13:38:00.008+01:00

Health economists indicate that Wales will suffer the biggest real-terms cut in NHS spending compared with England, Scotland, and Northern Ireland (see the story here).

A freeze in cash spending obviously does mean an effective "cut" because of inflation but we need to watch out for NHS Health Boards trying to impose cash cuts in mental health services which actually means they would be being picked on more than other services. That is not to say that savings cannot be made in mental health services but these need to made intelligently and the savings used to fund gaps in mental health services - that's what the promised ring fence means or else it means nothing.

Hafal has pointed to two distinct areas where savings could be made:

(1) "Repatriation" of high-needs patients from expensive and untherapeutic placements out-of-county or even out-of-country where this is in the best interest of the individual patient.

(2) Rationalisation of mental health teams working within the community. This would require reform of the traditional CMHT functions and approach: instead of addressing problems planners and commissioners have "worked around" the CMHTs by setting up new teams, some very good but we need their modern approach to become the mainstream in a joined-up team.

In addition medium-to-long term there is a clear opportunity to rationalise commissioning of all secondary mental health services (80% of spending on mental health) through systematic analysis of the new, universal, individual Care and Treatment Plans required from next January under the Mental Health Measure. A wise LHB Director of Finance (and their Social Services equivalent) will see these Plans not as an additional expense but rather as a focused and efficient requirement for all expenditure on secondary services. In other words if it's not in somebody's Care Plan why are we paying for it?

In this they will have the support of patients who want spending to follow their individual needs, not to be told what's available and take it or leave it.

If LHBs and local government don't see the great opportunities presented by the coming of the new individual Plans for effective commissioning and spending then patients will need to tell them...