Tuesday 30 August 2011

Tacitus



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.





Friday 26 August 2011

Meaningful



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.

Tuesday 23 August 2011

Shocking 90%



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?

Monday 22 August 2011

Wiggly Vorm


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.

Thursday 18 August 2011

Seventy-Six Trombones



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.

Tuesday 16 August 2011

Hold The Front Page!



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.

Sunday 14 August 2011

Jack Army


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.


Friday 12 August 2011

After Puritanism



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.

Wednesday 10 August 2011

Information Hub



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".

Monday 8 August 2011

Getting to Know the Minister


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.

Wednesday 3 August 2011

Gestapo



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 si├Ęcle exuberance. Or am I just a pessimist?

Tuesday 2 August 2011

Minister Takes The Wheel



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.