Northbound

I'm on my way to Hafal's quarterly North Wales meeting stopping off at our Learning Centre in Aberystwyth to get some work done. I am distracted from humdrum chores by evidence of our local clubs' artistic activities on the wall and I have snapped and posted two examples - a fine mosaic of the iconic Hafal microbus and a neatly-executed collage of the 1970s which captures the eye-popping taste of that decade epitomised for me by the amazing style crimes of Roger Moore as James Bond: he may have had a licence to kill but surely nobody would have given him one to dress like that?

Money, It's a Gas

A lot of things come down to the money in the end so as the Assembly is having its first substantive discussion about the budget today Hafal's Peter Martin and Junaid Iqbal are staking out the Senedd with the objective of holding the Government to its word on protecting both mental health services and, generally, the most vulnerable people in our communities.

Let's remind ourselves what the Government has said about this...

“Health and social services has been protected from any cash reductions in its budget in 2011-12 and 2012-13 and receives a small cash rise in 2013-14. This level of protection reflects our commitment to ensuring the provision of frontline services across Wales.” (Draft Budget p.33)

“Revenue funding for 2011-12 and 2012-13 remains at the same level as the budget for 2010-11.” (Draft Budget p.33)

“We will continue to prioritise spending on mental health services. Approximately 12% of total NHS funding is ring-fenced for mental health services, and we will provide investment to support the implementation of the proposed Mental Health (Wales) Measure.” (Draft Budget 6.para.6.6 p.34)

“The Assembly Government is committed to ensuring the provision of essential social services. Social Services, in the main, are funded from the Local Government Budget and the social care element of the RSG includes the necessary resources to deliver a 1% protection above changes in the Wales DEL. We have also maintained investment in social services funded through the Health and Social Services MEG.” (Draft Budget 6.para.6.7 p.34)

That all looks promising but will actions follow words? Our message to Assembly Members and others keen to protect people with a serious mental illness and their families is to keep a close eye on the money by...

•Seeking a clear undertaking from the Assembly Government that resources for mental health services will be protected and that this is evidenced by transparent reporting

•Asking Vice Chairs of Local Health Boards (LHBs) – who have a specific brief for mental health – to check and confirm that services for people with mental illness are protected in their area

•Asking LHB Chief Executives and Directors of Finance to demonstrate how spending on mental health services is fully protected

•Checking with LHB Directors of Primary, Community and Mental Health Services that their experience matches what their LHB is saying is being spent on mental health

•Requesting from Local Authority leaders information and evidence of how services for people with a mental illness are being protected.

All this and more including a response from patients can be seen in our briefing here.

It can be an invidious thing to seek protection of one area of public spending over another but I think Hafal is also right within the context of mental health to argue the priority of people with a serious mental illness both on moral grounds (they are among the most vulnerable) and also for the simple reason that their dependence on public sector funding is much greater than other people's and in most respects they have little recourse to other ways to get by.



My post title today comes from Pink Floyd's "Dark Side of the Moon" (1973) which I used to listen to on my cheap Russian record-player when I was incarcerated in boarding school during the mid-seventies. There's a lot about mental illness in the album - the title is a reference to "lunacy" - but nothing all that profound. You can hear the relevant "Money" track here (it's musically distinctive in unusual 7/4 time apart from the guitar solo) and note the famous sound effects but (on reflection at an older age) trite lyrics...

Money, it's a gas
Grab that cash with both hands and make a stash
New car, caviar, four star daydream,
Think I'll buy me a football team

Although maybe there is a little satire in the lines

Don't give me that do goody good bullsh*t...
Share it fairly but don't take a slice of my pie

Water Water Everywhere

Dramatic events at Blog Towers yesterday as first our electricity and then our water supply fails, the latter not a cruel coincidence but a consequence of the resolute leccie contractors from Balfour Beatty digging up the street.

After struggling all day at around five their foreman tells me that they have discovered that the main cable right along fifty yards is a write-off so the whole street needs to come up not just a couple of judicious holes. Wistfully I say that they "obviously won't get that done today" but he looks me coolly in the eye and states unequivocally "Well, we will have to" and, sure enough, after desperate pick-axe and shovel work all evening, at midnight they reconnect and likewise the water people. I hope they were on at least "double-bubble" and maybe a bonus for getting it done quickly (because I'm not paying anyway) as this was heroic work in terrible wind and rain.

It was especially uplifting to see the surgeon-like delicacy with which the electrician stood at the bottom of a muddy hole in heavy rain under a feeble light to connect it all up just before it turned Sunday (perhaps they were strict Sabbatarians? Or did Mrs Blog's judicious distribution of tea - from bottled water heated by gas - play a part?). Meanwhile I spent the evening reading a book, pausing after each chapter to recharge my wind-up torch.

My post title from the Ancient Mariner (Water, water, everywhere,/
Nor any drop to drink) is apposite as we had no tap water in spite of the extensive local flooding. I have previously mentioned the author Samuel Taylor Coleridge's likely bipolar disorder in this post.

Treatment

Because Hafal is managed by people with a serious mental illness and their families (rather than by health care ethicists or hand-wringing Guardian-readers) we have never been very interested in the stale old “medical versus social” argument about mental health care. What our Members are interested in is getting the range of care and treatment they require to achieve recovery.

For people with a serious mental illness that often, but not always, includes medical treatment but (equally) it is folly to imagine that medication will go very far without other areas of treatment and care being systematically addressed.

The new Mental Health Measure itemised the 8 key areas which need to be addressed as follows:

(i)finance and money
(ii)accommodation
(iii)personal care and physical well-being
(iv)education and training
(v)work and occupation
(vi)parenting or caring relationships
(vii)social, cultural or spiritual
(viii)medical and other forms of treatment including psychological interventions

The more alert among you may have noticed that this is one less than the 9 areas identified in the Assembly Government’s Interim Guidance on CPA published previously. This is because two areas have effectively been combined, namely medical treatment and other forms of treatment.

This is more interesting than may first appear so bear with me!

Hafal has always been in favour of separating the two in the context of serious mental health illness because a single heading for treatment can allow a “traditional” professional to tick the box about treatment having actually only considered (and probably prescribed or recommended) a medical treatment. Let’s face it, that’s what normally happens at the moment. By contrast if there is a separate box for other treatments then the professional effectively has to propose other forms of treatment or explain a decision not to suggest a psychological or other therapy. That’s a useful pressure, we think.

However, I understand that in consultation events on the Guidance and the Measure some people thought it gave “too much status” to medical treatment to give it its own box. A well-intentioned point but a tactical mistake because in real life medical treatment is always at least considered for a serious mental illness whereas other treatments are scandalously often scarcely thought about.

Why is this important now? Because shortly the Assembly Government will be consulting on the format for Care and Treatment Plans required under the Measure and we need to ensure that:

Either: there are two separate sections for medical and other treatments

Or: if there is just one section (which is fine) then there is a requirement to record explicitly in that section consideration of both medical and other treatments.

A care and treatment plan for somebody with a serious mental illness can’t be called holistic – or even adequate – if it doesn’t include active consideration of both forms of treatment.

For an overview of treatments see Treatment for Severe Mental Illness - A Practical Guide and to get the broader context of an holistic approach to recovery see My Recovery - a Step-by-Step Plan for People with Serious Mental Illness .

Still 2010

Our first big walk of 2011 ends curiously in 2010, that is in the Gwaun Valley where the people hold to the Julian Calendar and so it won't be New Year until what will be 13 January according to the somewhat more widely accepted Gregorian recalculation. The sense of going backwards is reinforced as I find the walk tough being out of condition after the holiday when I didn't do much exercise.

Whatever the date may be the days are lengthening - I took the photo while driving home just before 5pm today (at Bethesda on the B4313 between Maenclochog and the A40) when it would have been dark a couple of weeks ago. Cause for a little bit of optimism though it is a long, long wait until spring.

Boyle Watch

Comedian Frankie Boyle is getting a reputation for offensive jokes, evidently aiming to become the Bernard Manning of our time. He has targeted disability a lot because there is ambiguity about where the broadcasting "line" lies. His latest wheeze was a sketch making fun of anti-stigma messages put out by Time to Change, the English mental health anti-discrimination project which Hafal and others hope to extend to Wales soon.

The sketch depicts an ordinary-looking man conveying an anti-stigma message but as the camera retreats a number of murdered children come into view, apparently his victims. The offending clip has been put on-line (poor quality and don't look if you might be upset) here and you can see what he is sending up here.

Quite rightly our sister charity Rethink has complained about this but, though unwelcome, Boyle's "joke" is a kind of recognition that the discussion about these issues is becoming mainstream; it also has the merit of being so crass and unfunny that, even if you make allowance for the bad taste, you would have to be a complete klutz to laugh at it.

Where Next for Hafal in 2011?

Happy New Year everybody and welcome back to worky blogging after the holiday fripperies of the last couple of weeks.

Yesterday Hafal’s management team met to look at the year ahead and the picture looks reasonably good notwithstanding the current squeeze. We certainly have several new developments confirmed not least from European funding and our substantial new Haverfordwest housing service is coming on-stream right now.

Meanwhile this is a good moment to remind ourselves what the key issues are for 2011 and beyond. I suggest the big five are as follows ...

(1) The Assembly Election

Hafal has an excellent track record of getting mental health onto politicians’ agendas at election time and we need to repeat that as the May election date draws near. The main lever in this game is to get parties and individual candidates to recognise that there are votes in mental health, in other words many voters will be interested in what they have to say about care and treatment for people with a mental illness because they or their family or friends are personally affected.

The problem is often the extent to which voters are prepared to raise the issues in the first place (because of stigma or lack of confidence in articulating their concern) and that’s where Hafal can help. We will publish not just a manifesto but also guidance for voters on how to raise issues not least covering the four matters listed below ...


(2) Public Expenditure

We are already actively engaged in the issues arising from the current squeeze having welcomed the Assembly Government’s declared commitment to protect mental health services and the priority placed on secondary health services and on protecting social care services for vulnerable people.

All good stuff but what guarantee is there that the NHS Local Health Boards and the Councils will put this into action? Our plan is to look for support from key players including Assembly Members, local councillors, and (importantly) the “insiders” who will want to protect services for which they have responsibility. We are particularly keen to encourage the non-executive Deputy Chairs of the LHBs (who have a brief for mental health services) to take care that LHB Chiefs and Directors of Finance don’t raid funding which should go to mental health.

In the same vein we also need to encourage LHB Directors of Primary, Community, and Mental Health Services to fight their corner on the executive side – specifically to take an active interest in comparing the funding which they actually get for mental health services with the reports submitted back by LHBs to Welsh Assembly Government!


(3) The Mental Health Measure

Although Her Majesty signed the Measure into law late last year some of the biggest battles may still be ahead. We need to ensure that the Regulations and Code of Practice for the Measure are sufficiently prescriptive and clear. We expect consultation on the Regulations to start very shortly and Hafal intends to conduct a vigorous campaign to ensure that the prescribed content for Care and Treatment Plans (to which all secondary patients will have a legal right under Part 2 of the Measure) sets out all the “life areas” which must be addressed holistically. A late opposition amendment did set out the key areas on the face of the Measure but it will be important to ensure that these are explicitly included in the format of the plans rather than just “alluded” to in notes or guidance.


(4) Benefits

For all that mental health patients are concerned about health and social care services it is a simple and unsurprising truth that they are most concerned about benefits. Why? Because though many or most have ambitions to achieve employment and financial independence they need the support of benefits while they work towards recovery – and those in work need the reassurance that they will be supported if they relapse.

Hafal is presently working on its response to the (UK) Government’s current review of DLA – if you’ve got any direct experience you want to share (many have already) then do let us know.


(5) The Future of Mental Health Services in Wales

Just because there is a public expenditure squeeze doesn’t mean we should give up on revolutionising mental health services in Wales – though the squeeze should point us towards a cost-efficient approach obviously.

Hafal’s overwhelming sense is that change is most likely to be achieved through the initiative of patients and their families rolling up their sleeves and taking charge both of their own circumstances and, whenever practicable, of wider services. They could wait forever for the top-down approach to work and there aren’t many signs of that, though consumers should of course engage with and try to get a real dialogue going with the Mental Health Programme Board which the Assembly Government has established - even though it has no executive powers.

Shortly Hafal will announce a new campaign to encourage patients and families to empower themselves using their rights under the Measure and bringing their experience to bear on commissioning and running mental health services. Watch this space!


Keep up to date by regularly visiting Mental Health Wales, Hafal and our excellent Facebook page which is alive with breaking news and snappy pictures, plus this Blog of course.



Postscript: I haven't got any personal New Year Resolutions but got off to a good start on New Year's Day by barbecuing sausages on the beach in West Wittering, Sussex, with old friend and educational consultant Nick Jarman who lives up the road. The view behind is over to Hayling Island, on the route of the British Heart Foundation's annual "Round the Harbours" bike ride - very scenic and includes two ferries (useful respite for those of only "average fitness" on the 35 mile route).