Six Bells

Hafal's clients in Blaenau Gwent have sent me the above picture, the latest of their contributions to Bethany Chapel, Six Bells (see below). The Baptist worthies should charge admission - a useful benchmark might be the Sistine Chapel which was 16 euros when I last looked.

Cripes!

So today we learn that one in twenty children has a "Conduct Disorder" - a newly-coined "mental health problem" which, we are invited to believe, is altogether distinct from serious naughtiness and bad behaviour. See the story here.

Reading this I glance down at the corner of my computer screen to see if it is 1 April - must be close? - but no it isn't. I am almost lost for words. Is there no area of eccentricity or other unusual behaviour into which mental health services will not insinuate their suspect diagnostic labelling (behind which follow the drug-peddlers and quack counsellors)?

In the old Soviet Union of infamous memory psychiatric diagnosis was used routinely to oppress people whose conduct didn't conform to the expectations of the state. Is it so different to diagnose and treat children because their conduct is inconvenient to their parents, educators, or the police?

Gambas A La Plancha

Following the scandalous events in the NHS in North Staffordshire it might not seem very ambitious to seek parity for mental health services with physical health services. But in practice you would have to be living on Mars not to have noticed the massive shortfall in quality and resources for mental health services in England and Wales (and beyond, no doubt).

Mental health patients and their families dare not even dream of getting the quality of response they would get for a broken arm or similar. And that is part of the problem - the spectacularly low expectations of patients to the point where it is almost impossible to measure unmet need because so many people have long since stopped bothering to ask for help because they know they will be wasting their time.

So we should welcome the Royal College of Psychiatrists' new report Whole-person Care: from rhetoric to reality (Achieving parity between mental and physical health).

My one caveat would be about public health. Messages to the public about maintaining physical health can occasionally go wrong but they generally say roughly the right things - for example about diet and exercise.

By contrast messages about maintaining mental health can be seriously misguided, especially when they are developed by mental health service insiders (including the voluntary sector) who are not necessarily the people you want explaining to mentally healthy people how they can stay mentally healthy. In particular it is unhelpful to invite people even inadvertently to treat their general problems as mental health ones, smothering them with the disempowering language of mental health. How much damage has already been done by the public's lack of differentiation between "sadness" and "depression", for example?

The best support that can be offered to people to maintain their mental health is available from families and friends, the Citizens' Advice Bureau, the local gym, and for that matter discotheques, the seaside, gambas a la plancha, Radio 4's Just a Minute, a cat nestling on your tummy while you read the Sunday papers with a giant cup of tea and a digestive biscuit...these are the things which give you "resilience", not studying an NHS (or even Hafal's or other mental health specialists') pamphlet or listening to some gloomy training.


Postscript:

Gambas a la plancha? Just scorch raw, unpeeled prawns at high heat on a cast-iron bakestone (planc in Welsh of course - interesting that we share this simple terminology with the Spanish) or frying pan. Fresh raw prawns are now available in Swansea market and elsewhere - much better than those cooked Norwegian ones or tiger prawns from thousands of miles away. For something fractionally more complicated check out this short film made by Eroski (the Basque equivalent of Tesco). Don't worry if your Spanish is dodgy - the pictures show it all.

Canmlwyddiant

So, it's 100 years since the birth of R S Thomas, the greatest English-language poet of the post-war 20th century (although a bitter critic of English culture). Whether R S is the equal of the best poet of the early 20th century - Thomas Hardy - is a moot point. Hardy wins easily on structure and form but R S Thomas arguably explores deeper truths. I have previously put them head to head here. In 1999 we nearly lined up R S through a local contact in Criccieth to judge a Hafal poetry competition but sadly it didn't come off and he died soon after.

I have an odd habit of getting up very early on Sundays and sometimes listen while out walking to Radio 4's "Something Understood" - a religious programme usually presented by Mark Tully. However, it is infuriatingly bad, an unholy (ho ho) mix of woolly Christianity and even woollier spiritualism. I don't say this because I am not religious (though I am not) but I can tell the difference between something rigorously argued and something...well, woolly.

So it was good this Sunday to hear a contrastingly excellent programme on Radio Wales (not known for great programmes I'm afraid) in the series "All Things Considered" in which R S's life and poetry were celebrated with a particular attention to his faith. If you are interested it can be found on this link.

Like a lot of people I enjoy Thomas because his poetry isn't airy fairy but about very concrete stuff. But this programme, which included contributions from the Archbishop of Wales, demonstrated convincingly how R S's observations of nature informed his understanding of God, not least through the cycle of renewal and resurrection demonstrated by the seasons of the year. There are some great clips of RS himself talking very precisely and succinctly about his beliefs.

I particularly liked the way he suggests that, in contrast to the natural world on Earth, cosmological physics, for example the apparently endless and mechanical system of the Universe, is not so much a matter of celebration as an object of fear. How honest that is, the point being that physics no doubt offers a true enough explanation of the material world but it offers nothing but a label of insignificance to mankind, notwithstanding all the obvious (and so dull) guff churned out about the wonders of science by Dawkins, Grayling and co. How shallow and insignificant these shrill "philosophers" appear beside the giant Thomas.

R S Thomas is notorious for a frigid humourlessness but I do think I can detect an acute, satirical sense of fun in the poet, admittedly buried deeper than space.

Mata Hari

The Heart of Wales Line's mascot cat inspecting the track

Not for the first time this winter - or is this supposed to be spring? - West Wales seems to have got off lightly with the weather. So I walk over 30,000 steps recorded on the trusty pedometer during the weekend (evidence above and below) as well as enduring an icy swim in the outside pool at the gym (the wind had blown the covers off).

But all that takes just three or four hours and, encouraged by a drought in watchable telly, I find time to read another modern novel which features a walk-on part for Sigmund Freud. This is William Boyd's Waiting for Sunrise, more an Edwardian Biggles adventure than a psychological thriller.

Indeed the Freud stuff is fairly superfluous in an improbable plot involving trench-coated spies and far too many Mata Hari-style femmes fatales - I lost count and almost gave up when the hero's mum...but, hold on, I better not say as you might want to read it yourself.

It gives nothing away about the plot to say that the hero bumps into Siggers in 1914 in a Viennese coffee house (where else?) and tells him he is a patient of a (fictional) English psychoanalyst practising in the city. Freud recognises the name and mysteriously refers to him as his "other Englishman". This is not explained anywhere else in the book so I assume it is a reference for the benefit of smart alecs who know about the early history of psychoanalysis (such as the readers of this Blog) to the only English-speaking member of Freud's circle, namely (the real) Ernest Jones.

But the in-joke fails because Freud would never have referred to Jones as English - not just because he was in fact Welsh but because Jones ceaselessly reminded Freud of the difference, even comparing the Welsh to the Jews (Freud and many of his circle being Jewish): Freud routinely described Jones as Welsh. A small point but symptomatic of a rather lazy book - Boyd has lost form.

In spite of the bad weather the wild garlic is abundant - pick it while it's tender

A Form Of Abuse?

Many of us have come across a few people who exaggerate their illness or disability in order to avoid work and claim benefits. To say otherwise is immediately to lose the credence of anybody whom you are trying to persuade to be more sympathetic about the problems which honest people have with benefits.

But I don't come across people with a serious mental illness who are exaggerating their condition. It is actually all too common for them to exaggerate their fitness because that's what their inquisitors evidently want to hear.

Sometimes, and saddest of all, their illness may be at a "high" point where they believe they can do pretty much anything and don't believe they are ill at all - and the consequences of that, unless the assessor is extremely well trained in distinguishing delusional beliefs from grounded ones, could be catastrophic.

Many scrupulously honest people are being put under intolerable pressure by assessments and in many cases losing benefits which they badly need and to which they are legally entitled. Some may get the benefits back on appeal; others will give up, unable to fight on under the intense worry and pressure, and so slide into severe poverty.

The evidence for this is the extent of mistakes being made in assessments: see the story here.

Hafal's view is that it is completely unacceptable for decisions about vulnerable people's livelihood and ability to fend for themselves to be made without the most solid support arrangements. At a minimum people with a serious mental illness need expert advocacy, skilled both in understanding mental illness and the benefits system, right alongside clients both for the purposes of filling forms and attending assessment interviews.

None of this support would help dishonest people but it would safeguard honest people from what some would call a form of abuse - taking away their scant resources without ensuring that they are first able to present the truth about their condition.

On a practical note: if you are applying for benefits or subject to assessment don't hesitate - get advice and support. A belt-and-braces plan is to approach both your mental health team and a benefits advice agency - making sure of course they both know who you are involving.

And, if a decision goes against you, unless you are really sure they got it right, then appeal.

Of course you can talk to your local Hafal project too and they will help - at the least by helping you identify the right agencies to approach.



Postscript:

Not everything costs money. Mrs Blog mysteriously told me to go to Body Shop before 31 March and say "Happy Bunny!" to the staff. Feeling a bit of a prat I did...and they gave me a £3 voucher! The only thing I could find under £3 was a bar of soap for £2 - they didn't give me change but you shouldn't push your luck I suppose. Get along there and claim your free soap...

Folly, Folly, Folly!

Hacked Off activist Hugh Grant following a night out

Some time ago I warned about the pernicious moves towards suppressing our free press - see this post.

So now it seems that the political parties have joined together to do this wicked deed, encouraged by the many MPs who have a vested interest because they have been caught out themselves with wrongdoing or embarrassing behaviour and by the powerful celebrities and millionaires behind the lobby group "Hacked Off" - many of them with rather obvious vested interests. Some powerful supporters of press restriction may have become embittered because the truth has been told about their disgusting behaviour such as using prostitutes.

The public is assumed to be supportive of restriction or at any rate passive because people tut and grimace about the behaviour of the Sun and other tabloids (and yet we still read them).

Folly, folly, folly! Now that the principle is established of government interference it is completely inevitable that the "the great and the good" will soon say that the system put in place is insufficient and tighter controls are needed. And soon enough this repression will have consequences for vulnerable people - including people with a mental illness I fear - because the bullies and exploiters will hide behind the new rules.

An exaggeration? No, because current law is already so used - note that nobody dared say anything about Jimmy Savile because of our punitive libel laws and vulnerable people suffered horribly for years as a consequence.

The price of a free press is that cruel things and things in bad taste will be published. As soon as the state intervenes to try to mitigate those things the opportunity is simultaneously created, as night follows day, for wicked people to get away with crimes against defenceless fellow-citizens.

A glimmer of hope - there are some signs that Fleet Street might not play ball. The trouble is that freedom of expression is too precious to be left to newspaper editors and proprietors to defend but, hey, any port in a storm - why not hold your nose and write to the Soaraway Sun urging them to refuse to cooperate?

Excellent interview with Ian Hislop exposing the injustice of the proposed new system here.

Clever Girls

St Hilda's College, Oxford, founded 1893

It appears that St Hilda's College, Oxford, has lost its sense of humour in recent years. See the story of their apparently heavy-handed reaction to a "Harlem Shake" which erupted in their library here.

They certainly used to have a sense of humour. I gatecrashed an official graduation party there in the long, hot summer of 1979 (please don't ask me what I was doing there) but was rapidly unmasked by their formidable Principal and Pro-Vice-Chancellor of the University the late Mary Letitia Somerville Bennett (it was quite easy to spot me as this was then a women only college).

Nobody's fool, the Pro-Vice-Chancellor quizzed me vigorously and quickly exposed my feeble attempts to explain my presence but, having established the truth, she called the vast assembly to silence and (to my acute embarrassment) introduced me as a special guest and ordered a flunky to bring me a sherry at once.

Perhaps she warmed to me as a fellow classicist. She was, I found out later, the world authority on ancient Roman grain supplies. She would have needed a sense of humour to study that.

This tireless and venerable academic would not countenance even a discussion about admitting men to St H's, once saying that the motivation of the men's colleges for admitting women was to get the "stupid men out and clever girls in" which sounds about right. I like to think that I contributed in a small way to the college holding out against admitting men ("But just look at how they behave!") until 2008, long after all the rest went co-ed.

Not The Usual Humbug

I am enjoying looking at our new guide for students which is based on the experiences of over 1,000 people with a serious mental illness and their carers and has been produced as part of a ground-breaking Comic Relief-funded initiative.

The guide, "A Recovery Approach to Mental Illness", is designed for formal and informal students in the areas of health and social care, mental health nursing, medicine, psychology and criminology, and provides an introduction to Hafal’s unique recovery approach which has proved successful for hundreds of service users over the past decade.

More recently our approach has been integrated into law under Part 2 of the Mental Health Measure so that now everybody using secondary mental health services in Wales can benefit from it! Any student in Wales who wants to study or work in the field of mental health will want to read the guide as well many further afield.

The guide has been produced by Hafal as part of the Comic Relief-funded Expert Patient Trainer Project, a unique training opportunity aimed at bringing the expertise of those who have a direct experience of mental illness to a wide audience of students, health professionals, employers, policy makers, and other service-users and carers.

Speaking about the initiative our Learning Centre lead Nicola Thomas explains: "Building on the successes of Hafal’s National Learning Centre, and in particular the contribution made by service users as trainer-consultants, the Expert Patient Trainer Project has worked to develop training for a variety of organisations in the educational, voluntary, private and public sectors.

"Through this new initiative service users and carers are developing and delivering courses and gaining their own training qualifications in the process. The aim is to empower these service users and carers, to give them a leadership role, and to reduce stigma.

"This guide is a key part of our strategy to deliver a service user perspective to health professionals in order to improve practice and introduce a recovery ethos into services."

Quite so - this is practical advice on achieving real recovery, not the usual humbug about "improving a sense of wellbeing" etc.

To download the guide click here.

Cathartic

Yesterday I am at the old St Helen's ground in Swansea watching Wales' Under 18s being comprehensively beaten by England (44 - 7 if you must know) in a freezing wind blowing off the Bay.

I'm no aficionado having peaked myself aged twelve and gone downhill from there (see this post) but I am here accompanying an old friend of my Mum's who has travelled from S E England to watch her grandson playing scrum-half for the wrong - sorry I mean the winning - side. Incidentally she and her daughter who is also present easily out-shout the Welsh spectators while I and Mrs Blog pretend we are not in their party.

The game is rather one-sided and our boys are not helped by the fact that the opposition has a prodigious kicker (complete with that annoying Jonny Wilkinson stance - but I understand it's the done thing now across the border and it certainly works for this fellow).

His only mistake is to get a conversion charged down in front of the posts, something I've never seen before though I remember optimistically attempting it myself on numerous occasions being one of the tallest in many a substandard side and so getting plenty of opportunities.

It was oddly cathartic to see it done finally thirty years after hanging up my boots - proper high-sided things with fearsome, weapons-grade metal studs which we always said were "safer", not a view shared by the miserable wretch at the bottom of a ruck flailed mercilessly and self-righteously because he "wouldn't get out of the way, sir, honest".

Ah, happy days indeed.

Gratuitous

Good to see our friends in Rethink are celebrating the role of pets in lightening the load of mental illness - see the story and pictures of various pooches, mousers, a rat, and a hideous fish (dear to somebody though) here.

This also gives me the opportunity to post another gratuitous picture of the little friends which both soothe my furrowed brow and, in equal measure, cause me anxiety through fighting their own kind and defecating in the gardens of ours.

Each to his own. I don't like dogs much (though I did once contemplate a lurcher to catch rabbits for the pot - but isn't that technically illegal now?) and, as Shylock notes in the Merchant of Venice, there are some that are mad if they behold a cat even though it is in fact a harmless necessary cat, a description which suggests that the maligned but pitiable moneylender - or Shakespeare? - didn't know much about cats frankly.


Postscript:

Actually not illegal, a lawyer friend tells me, but it is if you go after hares - a curious discrimination.

Judgemental

The case of Nicola Edgington is desperately sad and dispiriting - see news of the culmination of her trial here.

The main issue was the failure of services to respond to the patient's cries for help - yet again - but I was also interested in the judge's remarks, particularly where he says "Your actions...were a consistent and calculated course of criminal conduct".

Odd words to use about somebody with schizophrenia who believed that God had saved everybody else but not her, among other terrible delusions. How sure could Judge Brian Barker be that he would not pose a risk if he had the misfortune to suffer from such an extreme form of mental illness?

I don't mean that he should have released her - she evidently poses a serious risk - but it was cruel to imply that this woman was in the same position as anybody else and equally responsible for her actions. Our legal system is in reality a populist rather than a fair one, unable to contemplate the possibility that shocking things can occur without somebody being unambiguously condemned and held responsible.

Any fair-minded person can see that the right approach to people like Nicola Edgington is to understand the role of the illness in her actions and accordingly afford a degree of compassion to her at the same time as protecting the public by ensuring that she is held securely for as long as necessary - which may of course be a long time.

Open Mind

Interesting news that people who experience several common mental illnesses - autism, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder, and schizophrenia - share genetic characteristics. See the story here.

Hafal's friend and one of the researchers Nick Craddock, professor of psychiatry at Cardiff University, says: "It signals the opening of a potential new era for psychiatry and mental illness. This is a scientific method that helps understand what is going wrong in the brain, the chemicals, the brains systems, that are important in illness." He said that ultimately it could help devise treatments and better ways of diagnosing patients.

Of course what this leaves open is the relative importance of environmental experiences in comparison with genetic make-up. Put crudely if you were to identify a gene which everybody with schizophrenia (say) has (and nobody else) then you might prove that the illness was wholly caused by genetic make-up. If, on the other hand, you identified a gene which all people with schizophrenia share but so do twenty times that number of people without schizophrenia then you might be looking at a position where only certain people can ever get the illness but their chances of getting it may still be very largely down to environmental circumstances. At present nothing is as certain as these wholly speculative examples which I only use to make a point.

The important thing is to keep an open mind, neither rubbishing the significance of nurture in the desire to nail down an uncomplicated genetic cause, nor condemning genetic investigation through a Laingian obsession with the role of families and society. Patients want a pragmatic approach which brings full recovery ever nearer.

This point, and its significance for choosing treatments, is well laid out by Hafal here.

Oafish Chumps

It is Mrs Blog's turn to choose the entertainment so we are off to Swansea to see I Give It a Year. I decide that the way to get through this is to treat it as an investigation into the "wellbeing" agenda, i.e. how people use cinema to protect and enhance their mental health.

This is one of those rom-coms pretending to be a post-feminist chick-flick. You know the sort of thing - controlling and self-absorbed ladettes working out which oafish but strangely alluring chump they are going to marry.

The wellbeing therapy, to judge by the reaction of this audience, comes from a humorous expiation of embarrassing matters. So there is much laughter at the use of Latin anatomical words (which are admittedly funnier than the slang ones); and the high point is when some of the characters cringe-makingly attempt what is known as a "threesome", a project which is wholly unsuccessful because (or so it seems to me) they all keep their pants on - itself a mercy if that isn't ungallant to say.

Another element of therapy is obtained at the expense of the small number of men in the audience who are held up to ridicule for their chumpishness based on their similarity to the screen characters. After the show Mrs B generously confirms that I am not like the men in the film. Pushing my luck I ask which fictional screen characters I do resemble. Without hesitation (because this has clearly been thought through previously) she says "Basil Fawlty, Mr Bean, and Doc Martin". As we drive home in silence I wonder what these characters have in common apart from a bizarre sociopathy and complete inability to engage in normal human contact. It must be that they all wear a tie. But then I don't wear a tie...