Wednesday 27 February 2013

Horse Sense

Horse-meat for sale - a healthy choice but a bit sweet for my taste

I don't know about you but I'm getting increasingly bored by the furore over horse turning up in beefburgers. Some perspective please! Tests show that a tiny number of products have included some horse meat and none of them could have done anybody the remotest harm - in fact horse meat is healthier than beef by some margin as it is very lean. Naturally we should pursue criminals who have made a buck out of substituting horse flesh but it is no big deal.

The most annoying aspect of all this is the gloating and gleeful jumping up and down of super-rich foodie campaigners telling us all how stupid we are to trust supermarkets and how we should all be trooping off to the local "farmers' market" and snooty high-class butchers to pay through the nose for basic foodstuffs.

This just upsets and offends those many people who can't afford to buy fancy food and now feel guilty and inadequate because the millionaire foodies are effectively accusing them of not providing their families and themselves with decent, healthy food. This obviously includes many people with a mental illness who may be more than averagely disturbed by all the fuss.

Can I offer some comfort?

A moment's thought will tell you that you are far, far more likely to get something dodgy from an independent butcher or other supplier (however "superior" or friendly to their customers) because among them there will be a significant proportion who are tempted through greed to bung something foreign or even condemned into their mince or other products.

By contrast supermarkets are "super-careful" to ensure the integrity of their products, not because they are nice people (though there is no reason to think they are nastier than an independent supplier) but because their reputation is precious, failure is horribly damaging, and there are hundreds of potential whistleblowers working for them who would stop them in their tracks.

So by all means use independent suppliers if they've got what you want but don't hesitate to use the supermarket where the products are equally healthy and probably safer.

Stand and Deliver!

Take a look at the redesigned journal Mental Health Wales here complete with an agreeably undignified cartoon of leading Welsh Government Ministers. Will they deliver? That is the question now that the legislation and strategy are in place...

The money is important and the ring-fence (the least sexy but most important thing in the strategy) could at least protect the resources if properly implemented. But I still worry about this idea of "culture change" - certainly needed but can it be achieved through recruitment, training, practice guidance, and appeals to professionals' consciences?

Only very partially, I suggest, because there is no reason to think that the managers and front-line professionals in Welsh mental health services (and I include the voluntary sector) are inferior in skill or dedication to those elsewhere.

We will never accord sufficient respect and provide first class services to patients and families until they have real choice and control over the services they use.

Friday 15 February 2013

Horse Strength

Penny Cram and Junaid Iqbal with Labour MPs

Apologies for the lack of posts: I succumbed to tooth-ache last weekend and I am only now getting on top of it with horse-strength antibiotics (you have probably had some yourself if you enjoy frozen lasagne and "beef" burgers). Extraction of the offending molar is scheduled for first thing Monday morning after which I am meeting the Welsh Government - really not as bad as pulling teeth I'm hoping.

Meanwhile mine was the lead letter in the Western Mail on Monday. You may be wondering - was it about the Mental Health Measure, or perhaps the new Welsh Social Services Bill? For shame it was not but rather about events over 500 years ago now suddenly topical - see the on-line version here.

Now, already slightly regretting this dilettante excursion, I have been approached by a charming journalist from Wales on Sunday wanting to expand my thesis for an article this weekend. Look out for the name check which I understand will be as "amateur historian Bill Walden-Jones". Isn't everybody an amateur historian? I mean apart from professional historians like my boss, Hafal's distinguished Chair of Trustees Dr Elin Jones, of course.

While I am wasting time on this stuff it is fortunate that other Hafal staff are taking their duties seriously, including our Criminal Justice Lead Penny Cram and National Assembly lobbyist Junaid Iqbal who have returned from a very successful foreign trip - to Westminster where they held a series of meetings with Welsh MPs of all parties in order to set out our Members' concerns about a range of matters including reform of the benefits system. See more here.

Friday 8 February 2013


Just come across the evidence that pets are good for your mental health on our friends the Mental Health Foundation's site here.

I would argue that from a psychological purist's point of view cats are better than dogs in as much as they provide companionship but resist creating a sense of dependency - even though they are happy to take your food of course. But if it helps to have some animate being to look after then a dog is the thing obviously and it will be endlessly grateful and probably won't leave you alone.

But my cats aren't an unqualified success in creating ease and "well-being" because they get into scrapes with other cats, in particular a well-bred but thuggish blue job a few doors down, and there is that insoluble problem of digging holes - and the rest - in neighbours' immaculate flower beds.

However, there is no doubt that they keep life interesting and my two have developed markedly different personalities. Rhys (ginger blotches) is the adventurous trouble-maker while Huw (black blotches) is lazy and knowing - and getting large to the point where he is now known as "Huge" or sometimes even "Eric".

Thursday 7 February 2013


Hafal has joined forces with over 50 charities across the UK to form the Disability Benefits Consortium (DBC), a group committed to working towards a fair benefits system. The DBC seeks to ensure UK Government policy reflects and meets the needs of all disabled people including those with a serious mental illness. Take a look at our work here.

Meanwhile long experience has told us that you can't engage clients effectively about employment if you don't simultaneously cover benefits because of the understandable anxiety and practical concern about the potential impact of seeking work - or even expressing interest in work - on an individual's benefits.

This has always been so but in recent times the benefits reform agenda of the present UK Government - and most recently the 1% cap (which means a real-term cut) in some benefits including ESA - is preoccupying clients more than ever. For this reason our Lottery-funded Small Steps employment project includes information about benefits in its advice to clients: see more about the project here.

Wednesday 6 February 2013

R.I.P. Car Parks

Your correspondent sizing up St Peter's Church, Carmarthen. Rhys ap Thomas' tomb is inside, prominently placed off centre at the altar end of the nave

Poor old Richard III Society! This is the deluded group which makes out that Richard was a thoroughly nice chap who was misunderstood. One of the Society's claims has always been that Richard's crooked back was just Tudor propaganda and they successfully got most historians to agree.

But the discovery of Richard's body in a Leicestershire car-park (see the story here) shows that he did indeed have a pronounced twist in his spine. The Society should embrace this and celebrate their hero as a role model for people with physical disabilities - he was certainly courageous and famed as a fighter in spite of his problem. Somehow I suspect they won't, any more than they can bring themselves to accept the clear evidence that their hero murdered the Princes in the Tower.

Another ancient story from Bosworth Field (widely dismissed of course by the same historians) is that Henry Tudor's faithful lieutenant Sir Rhys ap Thomas actually killed Richard in the battle by whacking him on the head with his pole-axe (basically a combined axe and blade on the end of a pole). As contemporary poet Guto'r Glyn (a Yorkist soldier, oddly enough, so no Tudor propagandist) testifies "Lladd y baedd, eilliodd ei ben" ("He slew the boar, shaved his head") - the boar was Richard's symbol.

Actually you read it here first long before the scientists in Leicester examined the bones.

And, lo and behold, the criminal usurper's skull unveiled this week clearly shows the evidence of Rhys's fatal blow. Next time I visit St Peter's in Carmarthen I will pause to pay respects at the tomb of this (until now) unrecognised regicide who brought the whole of Mediaeval history to an end with one swing of his formidable - and distinctly Mediaeval - weapon.

Incidentally Rhys too might have ended up in a car park because he was buried in the Priory in the centre of Carmarthen, the site recently of Tesco's and latterly Wilkinsons. Fortunately, however, his body was moved to St Peter's when the Priory was dissolved by Henry VIII whom he had also served loyally after Henry VII died. Correction 8 Feb! I was muddling the site of Carmarthen's Priory with the site of the Friary - actually Rhys's former burial place is now a play-ground or allotments so far as I can see...

World-Wide Betrayal

Take a look at the Aviva "Health of the Nation" survey of GPs in England and Wales here especially page 26 onwards which covers mental health - the research dates back a while but it was only published last week. This indicates great concern among GPs about the state of mental health services and their own capacity to help people.

Two points stand out: first, doctors are increasingly concerned about the volume of problems raised by or about children and young people; second, 65% of doctors admit to prescribing anti-depressants when psychological therapies or "social care" would have been preferable. A major factor in the increase in young people presenting problems is acknowledged to be greater knowledge about mental health matters.

Now, greater knowledge is a good thing but you have to ask if it is a good net result if people end up getting the wrong treatment and, more sinister, if people without mental health problems get medical treatments such as anti-depressants when they really need practical support with a problem which is external such as unemployment or debt. These external problems can of course lead to mental health problems but by no means necessarily. If in fact somebody has concerns or sadness which are proportionate to their circumstances then drugs may just hold them back from sorting out the problem or working through their sadness.

In the case of children the massive increase in using drugs to deal with "behavioural problems" is nothing less than a world-wide betrayal of huge numbers of young people. There are of course children with major problems for whom medication may be a last resort but that does not remotely justify the almost casual use of drugs as a "panacea" for dealing with difficult or troubled children. There has been some admirable resistance in the UK to the trend in the USA towards diagnosis encroaching ever earlier into childhood - not least "paediatric bipolar disorder" which is a highly suspect diagnosis.

Nevertheless there seems to be a disturbing move away from the working assumption that children should be able to find their way to adulthood in sometimes odd ways but you really don't want to intervene with drugs to make them conform to society's expectations. We should try to reverse that trend and think twice before medicating adults too except where really necessary for them to be safe and functioning.

Friday 1 February 2013


It is time to fight back against a longstanding prejudice shared alike by thoughtless, old-fashioned mental health professionals and by thoughtless, "progressive" mental health campaigners, namely the call to make psychological therapies available to those using primary care services without mentioning those using secondary mental health services.

The old-fashioned types either don't like psychological therapies much at all or else they think they are a waste of time - or worse - for people who have serious illnesses. I recall a speech by an eminent psychiatrist who asserted confidently that psychological treatment for people with schizophrenia would most likely just "upset them" by "raking up childhood experiences" etc, demonstrating that he was unable to distinguish a proper concern about silly Laingian flim-flam (see this post) from the value of deploying the right talking therapies to assist people at any level of illness including colourful psychosis.

The thoughtless progressives, on the other hand, tend to just forget about the people who are seriously ill when they discuss psychological therapies (that's if they ever remember about them) or else they are uncomfortable with discussing the role of psychological therapies in the context of medical treatments, preferring to stick to simple principles like "talking good, drugs bad" which is fine for many cases of anxiety and moderate depression but isn't the reality for most people in Hafal's client group.

So, let's be clear: Hafal calls for...

1. The availability of psychological therapies across Wales for people who experience a psychotic illness as a matter of routine.

2. A priority for psychological therapies to be available first to people who experience a psychotic illness and who are in greatest need.

3. Psychological therapies for people with a psychotic illness to be available and widely used within mental health units and hospitals - and to become a standard provision.

4. Psychological therapies to begin as soon as possible for people with psychotic illnesses - as NICE guidelines state - and started in the acute phase.

5. The availability of a full range of psychological interventions. People receiving secondary mental health services are likely to need specialist psychological interventions, but are also likely to have primary care needs too (anxiety, depression, etc).Therefore, people receiving secondary mental health services should have the full range of psychological interventions available to them.

See our excellent guide to both medical and psychological treatments here.


Please don't mistake my distrust of sloppy anti-psychiatry for thoughtless pro-psychiatry. I am as troubled as anybody by the claims of psychiatry over the years and to this day - and the best psychiatrists are surely those who are most hesitant and cautious about the very principles upon which the authority of their profession is based.

If you want to examine this difficult subject then see how much you agree with the thinking of Thomas Szasz who died recently having pressed over the last 50 years one of the most coherent attacks on conventional ideas about mental illness and its treatment. I don't agree with quite a lot of what he says - but he lands some hard punches.