Friday 30 May 2014

Pivot And Twist

Great pivot and twist from Elin in the rugby passing game

Let's Get Physical! reached Merthyr today at an event which got people on their feet!

Activities included a football penalty shoot-out, exercise work-out, rugby passing game, badminton, walking and a bike ride.

Guests also enjoyed a healthy lunch to fuel all their activity - and had the opportunity to get a physical health check in our Mobile Health Centre.

Service user Ron said: "My advice to people with a mental illness and their carers is to get outdoors! We're so lucky in Wales to have loads of open space to make the most of - and loads of hills and mountains to climb. We're going to continue to 'Get Physical' throughout the summer by running our walking group and accessing more outdoor activities in partnership with organisations such as Natural Resources Wales."

Hafal Carers Worker Gill added: "We also have a weekly healthy eating lunch club to promote a good diet. And of course our clients will be thinking about what health goals they can write in their Care Plans so that they can build healthy living into their everyday life."

There you are again, perfectly encapsulated - healthy exercise and healthy food can be taken in socially and with pleasure. It doesn't - shouldn't - have to be about staring bleakly at the bathroom scales at your feet while nibbling a cardboard-flavour Ryvita: it doesn't work and it isn't worth it. You have to find the fun in it all.

Laughing Gas

News today that half of us in Wales haven't seen a dentist for two years - see the story here.

I'm reasonably good about going to my dentist and anyway he constantly threatens all his patients with expulsion from his NHS list if they don't tip up - and you won't get back in easily except as a private patient so my Cardi instincts keep me regular, as it were.

As a result my teeth are reasonably healthy although eccentrically wonky as illustrated in the unflattering cartoon of me which is permanently displayed on this Blog (look right).

I'm fortunate in not having a phobia about dentists in spite of some hair-raising fillings and extractions as a child. It wasn't unusual then to expect you to put up with considerable pain, especially from drilling.

And "laughing gas" was no laughing matter (I can remember disturbing dreams while under what is known to doctors as nitrous oxide) but I gather from the net that gas is used much more intelligently these days though I can't find anybody who has had it recently.

My Dad had a joke about a man who went to his dentist for an extraction. Because he was scared the dentist quietly told his assistant to jab a needle into the patient's bottom at the exact moment when the dentist tugged out the tooth. Job done the dentist asked his patient how he was and he replied "It was fine, thank you, but I had no idea how far the roots went down!". Well, we thought it was funny.

But it is much better now and, though some dental work can be uncomfortable - my wisdom tooth was particularly stubborn I recollect - you needn't normally experience pain because the local anaesthetics are very good.

It's an important part of our Let's Get Physical! campaign to encourage people with a mental illness and their families to look after their teeth, meaning getting to the dentist regularly as well as all that brushing and flossing.

If you don't have a dentist then follow this link or this one. I've tested these and they seemed to find my local dentists but - take care - if you filter out the ones "not accepting NHS patients" then many disappear even though they do have NHS patients (all my local ones disappeared but I know they take NHS patients).

Presumably this is because they are "full up" but don't let that put you off. Ring up or go round and see what you can negotiate. The waiting time to get on their list may not be so long or you may be able to get aboard as a local person, because your family has used the practice, or because you make a good case by other means.

Polite assertiveness can go a long way in securing many NHS services - perhaps it shouldn't but it does.

You could go direct to your Local Health Board too for help.

Local Hafal staff (or our partners in the campaign - Bipolar UK and the Mental Health Foundation) or your Care Coordinator can give you a hand if you aren't sure how to proceed. And if you are scared of going to the dentist then talk to us or to your Care Coordinator - it's important to get help to deal with that.

Friday 23 May 2014

Two Birds With One Stone

That's what I call a proper menu - top that, Gordon Ramsay!

Our fantastic Let's Get Physical! campaign reached Rhondda Cynon Taf today when the camper van and Mobile Health Centre rolled into Aberdare.

Guests had the opportunity to get a physical health check in the Centre, take part in gym exercises and enjoy a healthy lunch.

Derrick, a service user at Hafal RCT, tells us:

"The campaign has also inspired us to start a walking group. This will be an important step for us - it means we'll have an ongoing project to get our teeth into.

"This is what the campaign is about - making long-term changes. Walking is a great form of exercise, not too strenuous and great for the heart. And it's a great way to socialise. I'm really looking forward to this summer!"

Inspirational talk, thank you Derrick, and let's hope we have a great summer so your walking group can enjoy the sunshine.

And a good point that the group will also help people with another of the eight "life areas" which together contribute to recovery, namely social life. So two birds with one stone.

Once In A Generation

The NHS in England

An insight into how mental health services in England are organised differently to Wales can be gained from this story published today.

Bristol's NHS Commissioning Group (no such thing in Wales) is no longer prepared to use just the local specialist NHS Mental Health Trust (no such thing in Wales) but is instead putting community services out to tender wholesale (theoretically possible in Wales but no likelihood of it happening any time soon) because of widespread dissatisfaction among patients and families.

The likely outcome is a new service run in partnership between a number of community-based organisations.

Service users and carers have been extensively consulted and Lou Winstone, who has used mental health services and took part in the consultation, said she looked forward to "an improved and modernised service" which would be "more responsive and compassionate".

Of the consultation she said: "There is a sense that the service users' and carers' experience, views and expertise have been valued considerably more than in the past". She added that she hoped the new approach would make "recovery the norm".

And local MP Dawn Primarolo (Labour) says the new arrangements offer a "once in a generation" chance for change.

Now, time will tell whether the new service is better but it is interesting to reflect that the independent commissioners can try something new when the current provider doesn't deliver.

In Wales the potential "commissioners" (Local Health Boards) are of course also the providers and I leave it to you to decide how likely it is that they will reject their own services and look elsewhere other than on a marginal basis.

England's NHS structure leaves much to be desired but this side of the border we do need a Welsh solution to the challenge of ensuring choice in mental health services, whether it is choice by commissioners based on what patients tell them or (better still) choice by individual patients who can select what they want and reject services which don't respect them or don't help them stay safe and recover.

Thursday 22 May 2014

Cool Cymru

It is a challenge to make Wales look stylish through imagery because you are expected to use all the usual industrial schlock (winding gear typically) or miserable rainy landscapes - or, closer up, some cute sheep - but when I saw this image on our Facebook platform I thought hello I would like to put on my coolest duds and make a visit.

But then I remembered I am already here.

It's a matter of mood and attitude. With the right mind-set Swansea's Wind Street can match West Hollywood's Sunset Strip, can't it?

Smell Test Failed

Important to shed light on a well-hidden but distressing problem.

I remember a few years ago when Hafal's Trustees first discussed prisons in depth and agreed that it was difficult to imagine a more oppressed group of our clients than women with a serious mental illness who are in prison.

It is always inappropriate for somebody with a serious mental illness to be in prison - where it is absolutely necessary to take somebody away from their home they should be in a health setting with the minimum necessary security. But this injustice is compounded because women prisoners are all incarcerated outside Wales and so a long way from home.

Hafal Criminal Justice Caseworker Anna Graham spoke on last night's The Wales Report (BBC 1 Wales) about the anguish experienced by female prisoners incarcerated across the border - far away from family and friends. She said:

"It is distressing when you go into prison and you see someone who was OK two weeks ago and now they are in a real state."

That sums it all up. Above all it's inhumane and cruel to a vulnerable individual to lock them up but in any case it doesn't work for the rest of society because it typically makes the individual more ill.

Time surely to think this through properly and find the humane, caring, effective, and indeed cost-effective alternative.

Meanwhile this remains a scandal for which we should all be ashamed. The UK has a fairly honourable ranking in many aspects of support for vulnerable citizens but this is one area where our reputation doesn't pass even the simplest smell test.

Watch the whole programme here and see our coverage on Facebook here.

Wednesday 21 May 2014

Contrasting Crunch

Fizzy has a point to make

Here's a tip from Fizzy the unofficial Let's Get Physical! maggot...I mean mascot:-

He sings the praises of frozen spinach. It's cheap, nutritious, easy to prepare, and delicious. It's available everywhere but a good buy is Sainsbury's 2 kilos for £2.50 - see here. Fresh leaves in a bag will cost you about five times that price per kilo but nice for salads.

You can grow spinach easily in the garden - or try perpetual spinach: it's a bit coarser but keeps coming which is handy.

But actually frozen spinach is a great product which loses almost nothing from not being fresh; and one of the useful qualities of spinach is that it has a substantial, almost meaty texture and taste so you can make a satisfying meal without gobbling down too many calories.

A classic for breakfast, lunch or dinner is spinach on toast with a poached egg on top: just follow the instructions to heat up the spinach (and you may need to squeeze out a bit of water and roughly chop it up), poach your egg and away you go - lovely yoke oozing sensuously through the spinach and the contrasting crunch of the toast. Mmm.

There are recipes which call for olive oil or parmesan but Fizzy is adamant that you should resist such continental frippery and stick to the UKIP version - just add a little salt and pepper to taste.

If you are a bit daunted about poaching eggs try this link and pick your method. But whatever you do don't microwave your egg unless you want it to bounce off the plate - microwaves have many valuable uses but eggs aren't one of them.

Spinach is good for you. Note in particular it's a source of calcium and vitamin A as well (famously) iron. For the record it also contains vitamin C, vitamin E, vitamin K, magnesium, manganese, folate, betaine, vitamin B2, potassium, vitamin B6, folic acid, copper, protein, phosphorus, zinc, niacin, selenium and omega-3 fatty acids (for which there is some evidence of a useful effect on Bipolar Disorder - and it's in your poached egg too!).

The wise readers of this Blog will already know that the concept of "superfoods" (wondrous stuff which miraculously prolongs life) is a deception put around by cranky health food shopkeepers - but the nearest real thing to the concept is probably spinach.

Thanks, Fizzy.

And here's another advocate of spinach...

Monday 19 May 2014

Onwards And Upwards

See the fantastic pictures and stories from the first of our 22 county events in Bridgend. You are spoilt for choice...

‣ Go to the Campaign's dedicated website here

‣ Or to our Facebook platform here

‣ Or tweet away here

‣ And you will also see coverage on Hafal's site here

‣ And indeed on our information service Mental Health Wales' site here

It's all happening in Bridgend and not just at the event: great to see a range of activities including soccer coaching with Neville Southall, a healthy cooking scheme, and a climb up Pen-y-Fan!

Onwards and upwards with the summer Campaign...

Saturday 17 May 2014

Let's Fizz - My Plan

Cukes in Mrs B's unheated greenhouse

Mrs Blog has achieved a personal best by growing cucumbers ready to eat before mid May - evidence above. We are looking forward to basketfuls of healthy salad and other veg following the mild early spring.

Part of my personal Let's Get Physical! plan for this summer is to do some fishing - good exercise and there is also the distant prospect of catching something healthy to cook and eat.

Personally I only do sea fishing which is generally more energetic than the freshwater game or coarse varieties (and a lot cheaper). My great grandfather David John by contrast was a keen game fisherman when he wasn't busy running the family's Felinfoel Brewery (no, I don't personally own any of it sadly). You can see his satisfaction with a good day's sport in this photo -

He looks rather small but that is just because these are truly mighty fish. To demonstrate this I have conducted a crafty piece of historical research as follows...

A 30 lb salmon is about 41 inches long (you can find calculators for this on the net). In the photo on my computer screen the brewer is 15 cm high whereas the 30lb fish is 8.2cm. Ergo that canny slaker of Llanelli furnacemen's prodigious thirst was (15 /8.2) X 41 inches = 75 inches = 6ft 3inches tall. I'm 6ft 4inches but that must be evolution.

But there is room for error as quite possibly Teifi salmon (that's where he went) are unusually long and thin or squat and fat?

Here he is again with an unknown chum or possibly employee. Perhaps I too should wear a tie when I go fishing?

Friday 16 May 2014

Truly Comprehensive

Ever tried to work out how mental health law in Wales, the Welsh Government's strategy for mental health, and their current delivery plan fit together? And did you try to distinguish what bits of all those things apply to people who are seriously ill, to those with lesser problems, and to the rest of the population?

If the answer is "yes" to these questions I might be tempted to suggest you get a life!

But, seriously, it is important that you do understand the big picture whether you are a politician, policy maker, commissioner of services (are we allowed to call them "commissioners" these days, not sure?), health or social care professional, or a consumer of those services (I'm sure we aren't supposed to say "consumer" but I like it - it presumes a right to choice and respect more than "user").

So here is some good news!

Longstanding Hafal senior consultant Phil Thomas, with his unequalled background in mental health services in England, Scotland, and Wales, has  produced a truly comprehensive Working Guide to Mental Health Policy and Legislation in Wales which we are making available through Hafal's in-house information service Mental Health Wales.

Find it on this link.

Trust me, I've been trying to grasp this stuff for months but only when I saw Phil's analysis could I see the picture so clearly - and it shows up the weak points as well as the strengths which is particularly valuable to campaigners.

Essential reading for professionals who had best get stuck in before they bump into a consumer who has read it and will be able to tell them what they are supposed to be providing!


Yes, essential reading but, Phil won't mind me saying, not for the beach.

If you must read about mental health services on holiday try the caustic, funny and disturbing In a Country of Mothers - a reminder by my current favourite author A M Homes that talking therapy depends entirely on the skill and integrity of the therapist.

This story shows how badly wrong things can go when the integrity isn't there, a useful reminder that we have to watch out for all that poorly regulated therapy which hides behind public and patient enthusiasm for psychological treatment - which is fine but dangerous if uncritical.

There are plenty of snake-oil merchants prepared to take your money to listen to your problems and give you bad advice; worse, there are occasionally wicked practitioners who exploit vulnerable people.

Nobody should use a counsellor or therapist who isn't fully accredited but even the respectable accrediting bodies vary in how much they actually check people out.

Watch out for our campaign on treatments this autumn and meanwhile there are contacts for accrediting bodies and further advice in our treatments guide here.


Our brilliant Campaign website - look here

I'm catching up after a hectic week and only now had time to look at the pictures from last week's launch of Let's get physical!

And what a good event it was courtesy of the indefatigable Emma Billings and lots of other stalwarts who made it a huge success. The great thing with these events is both to drive the point home but also show everybody a good and memorable time: in that we succeeded in spades.

Some choice moments for me...

Is this a dance movement or a sign of despair?

Introducing Liz Hails who spoke for carers on the Panel running the Campaign...

The joke was that we were getting soaked - strange how the camera doesn't show the rain?

After the dancing the food of course...

Our Let’s Get Physical! campaign sets a challenge for service users and carers to radically improve their physical health. People with a mental illness and their carers will set their own physical health goals by:

• sourcing and preparing healthy, high quality, good value food

• finding ways to become more active

• getting the right support from health professionals to stay well

...but of course we need the politicians, policy-makers and health professionals to play their part too: don't miss the section on the website for them (hyperlink here).

Meanwhile see the latest edition of Mental Health Wales - a "Let's Fizz" special - via this link. Don't miss the inspirational interview with Campaign Panel member and allotmenteer Nigel Griffiths!

Friday 2 May 2014

Extra! Extra! King Lear Kills Fool!

The King finds an in-patient bed

It was back in 2011 when I used this Blog (link here) to examine the overt theme of mental illness in King Lear – I had just seen the Donmar Warehouse production beamed live into the Maltings Theatre in Farnham, Surrey. Derek Jacobi played the king and passed the "Can he carry Cordelia?" test adequately though there was some audience trepidation and an intake of breath as he set about it.

Last night I attended the new National Theatre production directed by Sam Mendes and beamed live into Theatr Colwyn. Simon Russell Beale was in the lead and surprised us by wielding his daughter’s unusually floppy corpse dextrously, impressive for a Lear who is short, portly, and puffs a lot but perhaps that was just good acting.

I am up here to attend an excellent meeting of our North Wales managers and Trustees who show great enthusiasm for our Let’s Get Physical! Campaign as well as their usual and longstanding commitment to the "day job" of supporting people with a mental illness and their carers through a variety of services.

Hafal Chair Elin Jones attends too and tells us it is her 70th birthday on Monday and so my present is a ticket for the play which Elin had spotted (the theatre is just opposite our North Wales office). I was confident that she has no reason to take it personally that Lear also has a theme of decline in old age because that doesn’t seem relevant to our lively and fully engaged leader! We agree it is a great production.

There is a further theme in the play of succession planning which is instructive. Although Hafal has no announcements to make on that at present it is only sensible that the Chair and Chief Executive consider such matters for the future.

But I don’t feel I need to consult Elin to assert that Lear’s succession plan was a remarkably poor one – essentially creating two autonomous Regional Managers selected on the basis of their sycophancy towards the outgoing regime while simultaneously demoting staff who were prepared to tell the truth and sacking the whistleblowers. This leads to a hostile takeover attempt (though this is seen off).

In this production the two wicked daughters are more than usually alluring and it is impossible not to admire them in contrast to the priggish Cordelia (did Shakespeare intend this subtlety of feelings? No doubt).

The one oddity in Mendes’ interpretation is that he has Lear kill his Fool in a moment of psychosis. This isn’t Shakespeare and it doesn’t have any obvious purpose. Lear does kill a henchman off-stage at the end of the play but that's completely rational and defensible as the fellow was in the process of killing his daughter.

I hope that the director didn’t feel this departure from the text was necessary in order to convey the depth of Lear’s illness. The author saw no need in the early 1600s and it is disturbing if today’s audience needs to see a homicide in order to associate mental illness with their tabloid expectations?


Lear was of course Welsh - probably fictional admittedly, but still definitely Welsh, one of Geoffrey of Monmouth's line of pre-Roman occupation British monarchs tracing us back to Aeneas, a hero of the Trojan Wars.

One line I picked up which I hadn't spotted before, a remark made by the Fool...

This prophecy Merlin shall make, for I live before his time

...a surreal joke - not only is he making a prophecy but foreseeing Merlin making it - confusing, eh?

Saucy cougars Goneril and Regan plus goody-two-shoes Cordelia and the King (in his prodromal phase)