Gone Fishin'

Fishing just West of Caerfai bay on the St David's peninsula: the weather is much cooler than last weekend so prospects not great. Ledgering with rag-worm doesn't work for us (you can get decent pollack that way when it gets warmer) but my kid brother Tom gets lucky with feathers and two decent mackerel are gutted and grilled within 30 minutes of being caught - beats any fancy fish when it's that fresh!

Llongyfarchiadau!

Congratulations to Hafal's Criminal Justice Link team ably led by Penny Cram (picture) on securing the organisation's fifth "Welsh Language in Healthcare" award - full story here.

Pontypool

The microbus rolls into Pontypool delivering its key messages on the "Road to Recovery" campaign...

- Wales has recently been given the power to create new mental health legislation and the Assembly Government has introduced a draft "Measure" (Welsh law). Hafal Members would like the new law and accompanying regulations to give all people with a serious mental illness a legal right to a holistic care plan, and to set out all the areas the care plan should cover.

As the Measure goes forward we are concerned to ensure that there are time-limits to guarantee that patients get their care plan quickly - more on this soon.

- We believe that in future all mental health services should be developed and delivered in response to individuals' care plans. This would mean giving each person a 'menu' of services to choose from so that they can exercise choice as much as possible in their recovery.

- Given the pressure on public spending, we want resources for mental health and social services to be fully protected – and for new resources to bring mental health services up to scratch.

Meanwhile in Torfaen there is also a pressing need to secure independent advocacy for mental health carers: watch this space.

Whose Benefit?

Follow this link for disturbing news about implementation of the Employment Support Allowance - the new benefit for people with disabilities. The Scottish Citizens Advice Bureau reports very serious problems with assessments, something which Hafal too has direct experience of. This is before further change heralded by Iain Duncan Smith (see my blog here). Hafal's advice to anybody with a serious mental illness who wants to claim ESA, is being assessed for the benefit, or is appealing a decision on ESA is:

GET ADVICE!

Best approach is to get help both from a benefits specialist like CAB and from an agency like Hafal which understands your illness - and you will need to involve your doctor.

Don't leave it to chance.

Lonely

Wheezing along at 8.5 kph in the gym (will I ever do an 8 minute mile again?) I see Simon Lawton-Smith of the Mental Health Foundation on the telly introducing their report The Lonely Society . I’ve now taken a look over a first cup of tea and the report, based on a useful survey, offers some measured, practical recommendations not I'm pleased to say including establishing a National Loneliness Board. I’ll let you read their ideas for yourself (follow the link above) but a lot of the suggestions depend less on the state and more on what we are now invited to call the “Big Society” – the new UK government’s vision of encouraging the community at large to acknowledge and reclaim its responsibility to look after one another. Well, I wasn’t born yesterday so if the Big Society idea proves to be a smokescreen for cutting statutory-commissioned social care we must be ready to cry foul. However, there surely is some truth in the notion that we have too much grown to expect the state to take care of the needy: in reality neighbourliness, family loyalty, and spontaneous voluntary action offer the best hope of dealing with problems like loneliness, supported by state services especially where people have a special vulnerability such as those with a serious mental illness. Loneliness can certainly affect mental health but equally serious mental illness routinely results in desperate loneliness. We are rightly concerned to provide good services to people in the initial crisis of first episode psychosis, when they relapse, or when an evident risk arises. But a vast number of people with serious mental illness are receiving scant and desultory services because they are not “in crisis” (that is causing a problem to anybody else). This goes back to my point about routine CMHT services (see here): since I wrote this I’ve spoken to several NHS and Social Services managers who acknowledge that a key motivation in developing specialist teams is to avoid placing new or demanding clients in the hands of CMHTs where they do not believe progress can be made. But what about all those people with a serious mental illness who don’t make trouble but are struggling with inactivity and loneliness? I will come back to this.

Meanwhile back at the gym I lay in the Jacuzzi and pondered that loneliness is surely a product of the diaspora of families and communities – so many of us live miles from our parents and siblings and those we grew up with. I remember in the Sixties the very old men sitting on a bench in the cross-roads of the village where I grew up (and of course left): they had presumably grown up together, fought together (perhaps to relieve Mafeking for Queen Victoria and later on the Somme), toiled together in the fields, and have now died and lie together in the churchyard. Of course they may not have liked each other for I all know but loneliness was probably not an issue. I recollect seeing one of those archaeology programmes (not Baldrick’s Time Team but the one with a bearded chap with a Landrover who every week recreated a face from a crumbly old skull) where they dug up an ancient Briton in a village then took DNA samples from locals and found one man who was definitely a direct descendant – far from feeling foolish that his family since prehistory had resisted all temptation to move even a mile up the road he looked rather pleased with himself and was clearly very jolly, no doubt surrounded by childhood friends and extended family. . .

Phew What a Scorcher!

Sunday lunch at Wasabi in Swansea's Uplands - a little piece of Japan marooned in West Wales to indulge fans of raw tuna - followed by an afternoon on the sun-drenched beach in central Swansea. Just opposite the Patti Pavilion is my usual target (but you've got to walk 200 yds East to make sure you don't stumble on the old sewage outlet invisible at high tide). The water is fabulously warm - better than anything I can remember in May or even June - if this is global warming bring it on (only joking). Best of three swims is just before high tide at 3.15: after the usual splashing around I do 100 breast strokes which I can still feel two hours later (not very fit at present).



The sand is so hot you can't walk far bare-foot but worth the effort to collect large whelk shells in evidence today along with the usual mother-of-pearl oyster shells which make exotic ash-trays. On the way home and still orientally-inclined a detour is ordered to the Wah-Yu Chinese supermarket (a few hundred yds up High Street from the station) where apparently frozen squid is good value.

Belle Vue Rendezvous

A “nice view” indeed – I find the VW microbus elegantly parked outside the ornate pavilion in Newport’s Belle Vue Park having chugged not very environmentally from last week’s Barry event. I arrive among a good crowd enjoying the sultry air and sunshine including John Griffiths AM, Counsel General and Cabinet Member in Wales’ coalition government and the supportive local Assembly Member for Hafal’s Newport base. We discuss the new Prime Minister’s offer when he came to Cardiff on Monday to let WAG delay cutting the Welsh share of that contentious £6 billion: John points out it would mean more cuts next year so not an easy option. In any case he acknowledges it is a relatively small part of a much greater deficit which must be dealt with by cuts or taxes. The key variables in how managing the deficit will affect services in Wales seem to be: -

• Does WAG delay cutting its share of the £6 billion (see above)?
• What proportion of the deficit is dealt with by taxation? A UK matter and we should learn more from George Osborne soon: that will determine the cut in what WAG is allocated.
• Is the Barnett formula going to be updated? Also in the gift of the UK government. If it is then Wales could get a better deal (Scotland less). Don’t hold your breath!
• Whatever funding does come to Wales will WAG protect NHS funding or indeed increase it? But that also leaves local government which will surely be squeezed.
• Will the Welsh NHS Local Health Boards or indeed the Councils honour the declared WAG priority for mental health when the chips are down?

Details of the Newport event will shortly be posted here and you can read about the whole campaign here.

For their event Hafal Newport has laid on a rival fixture to the Ryder Cup in the form of a complex golf game illustrating progress in mental health recovery: never much good at games I find the rules a bit baffling but everybody enjoys some gentle and not so gentle putting. Trustee Jazz has loyally made his way from Aberdare by public transport and reminisces about the old National Schizophrenia Fellowship in Wales (Hafal before independence and reformation) - he is rightly proud of being there at the start and helping manage development of the organisation. A dispiriting conversation with a longstanding client of our local service who has hit a major crisis brought on and then made worse by a substandard response from a key national agency - he praises our staff for doing their best to help: I only wish it was in our power to solve the problem. Nice salmon, tuna, and ham sandwiches, a cup of tea and a chat to Pam Johnson and other staff and volunteers before heading back to the less attractive view of my intray.

Sectioned

The BBC 4 programme on operation of the Mental Health Act (if you missed it see it on-line here) offers a little cause for optimism in the decency of some dedicated staff but also shows what Hafal Members know well: patients need a systematic, holistic plan for recovery supported by staff trained to encourage and support them using empowering, therapeutic techniques. In contrast we saw patients’ progress largely dependent on the commitment of individual staff - not something most patients can rely on encountering.

Fair Cop

Driving in this morning I hear new Home Secretary Theresa May squirming a bit over the “rock and hard place” which is Tory distrust versus Lib Dem support for the Human Rights Act – there’s going to be a commission on it which sounds like quite long grass! For now I’m interested in her plans for policing. The police are bound to get squeezed by public expenditure cuts but May is sweetening this by significantly extending police powers to launch prosecutions without Crown Prosecution Service involvement for things like minor assaults and theft.



Hmm. This places a lot of responsibility on desk sergeants to make the right judgements and I’m not saying they can’t do that: however, that new responsibility will make yet more urgent the need to provide guidance and training to the police on how to handle people with a serious mental illness, including when to divert them to mental health services rather than charge them. Hafal has recently begun to gain an invaluable insight into this as our Criminal Justice Link team is piloting a new “Appropriate Adult” scheme in Cardiff – providing a trained supporter for every person with an evident mental health problem when they are taken into custody. As we expected we are working very effectively with the police on the scheme and observing much good practice on their part (we have also noted the delay caused by waiting for CPS decisions). This reflects the generally good experience which Hafal’s Members report of their dealings with police officers: they are especially popular with carers of people with very serious problems because they will respond in emergencies when (frankly) mental health services regrettably sometimes won’t. For all this there remains a need for mental health services to engage much more effectively with the police to ensure that people with serious mental illness are treated fairly and compassionately in the community: they are of course much more likely to be victims of crime than to commit offences. For Hafal’s advice to people with a mental illness who get into trouble with the law see here; for our suggestions to improve services for people with a mental illness who are also caught up in the criminal justice system see here.

STOP PRESS
Over lunch I see May's speech to the Police Federation contrasting the "Broken Society" with the "Big Society" (see here): I think I understand what she means but I'm not convinced that this odd use of language will catch on. I also recollect the widespread satirical merriment when Tony Blair launched his "Big Conversation" in 2003.

Down South

To Chichester, Sussex, to see Nick Jarman, education guru and director of two software companies. Between barbecuing (all red meat I'm afraid - keep taking the statins, Nick) we agree that one to watch in the new government is Iain Duncan Smith at Work and Pensions. IDS is the inheritor of the "Frank Field tendency" - keen on wholesale reform of the benefits system to clear up anomalies between tax and benefits, incentivise work, etc. See what his Centre for Social Justice says about mental health here and a useful analysis by the Guardian here. Labour's Frank Field has of course bounced back into view with the new coalition having been dumped by Tony Blair years ago for "thinking the unthinkable" once too often about benefit reform; more about his reincarnation as "Poverty Tsar" here. Many Hafal clients have had bad experiences of the recent change to ESA so, if there is reform, we will need to see that those in genuine need are protected. Having put the world to rights over the embers we decamp to the Woolpack in Fishbourne where the live band hampers further discussion and we take to the dance-floor as (almost) the Oldest Swingers in Town (no pictures, thank heavens).

Carnivale

Sadly I missed the Vale of Glamorgan stop on the "Road to Recovery" campaign but enjoy the pictures and see their message here...

Seminar Success

Our Seminar "Growing Up and Serious Mental Illness" strikes the right balance between ambition for change and the reality check of limited funding for the next three or four years. Key participants include. . .

- Dr Mike Shooter CBE, Chair, Young Minds and Children in Wales, past President of the Royal College of Psychiatrists and former Consultant Child and Adolescent Psychiatrist, Gwent HealthCare Trust.

- Professor Richard Williams OBE TD, Professor of Mental Health Strategy, Welsh Institute for Health and Social Care, University of Glamorgan.

- Professor Richard P Bentall, Professor of Clinical Psychology, Bangor University.

- Dr David Williams, CAMHS Professional Advisor to the Welsh Assembly Government.

- Julie Edwards, Policy Officer, The Children's Commissioner for Wales.

- Sonja Hookway, Mental Health Coordinator, Swansea University.


. . . plus equally importantly young people with personal experience of mental illness and adults with a history of mental illness going back into their youth.



The testimony of those personally affected is courageously delivered, moving, and enraging - how could we not respond quickly and sustain support to anybody, let alone children, in such great difficulty? As ever, given no doubt reasonable and decent professionals, bad systems seem to perform even worse than no systems. There will be a report and action plan soon but meanwhile see the post-Seminar press release here.

The New Politics

Well, like I said, nothing will ever be quite the same again. The choreographed exchange of power yesterday evening was compulsive viewing following the extraordinary see-saw of expectations as the Lib Dems danced between their potential partners.

I propose to write a longer piece shortly on the implications of the new UK government for the services, benefits and legal framework which affect people with a serious mental illness in Wales. Meanwhile we all need to note two big changes:-

First, the four main parties in Wales are all both in government and in opposition (curious but not an anomaly – that would be to misunderstand devolution). . .



The other big change is that, for the first time since devolution, we are about to face significant decreases in public expenditure in place of significant increases. I hasten to say that this is not a consequence of the change of government in London, except to some extent in timing, because all parties agreed that cuts were on the way.

These two big changes will require a new sharpness on the part of consumers of public services in Wales (that’s all of us, but especially people who rely heavily on services such as people with a serious mental illness). We will need to distinguish carefully whom to hold responsible for changes in front-line services – not an easy task in the context of a global budget for Wales determined by the UK Conservative-LibDem coalition and then management and distribution of that budget by the Welsh Labour-Plaid coalition. We will need to scrutinise carefully both the global settlement and the Welsh budget to check out who is responsible. Of one thing we can be sure - whatever the genuine intentions of both governments to have a businesslike relationship they will be blaming each other when things go wrong. More on this soon . . .

What about the CMHTs?

There is much discussion in the mental health community about mental health promotion (informing the public about how to maintain their own - and look out for others’ – mental health) but, important though such matters are, they are not the priority issue and they impact relatively little on the front-line of secondary mental health services delivered in hospital and in the community which require at least 80% of the resources available for mental health services.

There is a less public but important debate among people concerned for secondary services in Wales about how to structure services delivered in the community. This debate can be illustrated by reference to the Welsh Assembly Government’s project to identify required practice and standards for services delivered to those who first experience psychosis. Hafal’s Sue Barnes and Keith Jones have been centrally involved in this important discussion, representing the patients’ and families' perspective and winning ready acceptance by colleagues involved in the project of the importance of an holistic approach to care planning. More contentious has been the strong inclination of many involved in the project to propose separate, specialist teams to deliver these services, based on studies of existing services and the compelling logic that if you want something done then having a team specifically dedicated and accountable for the required action will be most effective. But Hafal’s members and clients have always supported the concept of a single, but expanded and well-resourced Community Mental Health Team taking on and delivering new standards: the advantage of this approach would be efficiency and flexibility for the service and (more importantly) a consistent, familiar service for patients at the early stages, in the longer-term, in crisis, etc, rather than getting referred between different teams. All credit to those handling this project (Les Rudd from NLIAH in particular) that the different options for delivery of these vital new standards have been acknowledged. There is not much on this yet in the public domain but I understand that the guidance will be going out for consultation soon: keep an eye on the Mental Health Wales news.

I suspect that underlying this debate there is an unspoken belief by some conscientious managers seeking real change that CMHTs may not really be up to the job, won’t change, and so can’t take on and deliver new standards even if they were given the resources. Let’s be frank, this will be true of some CMHTs, even though there are many dedicated staff working over and above the call of duty to deliver the rather thankless and forgotten duties of CMHTs. Little wonder given the history of restricted resources and the recruitment of many keen and able CMHT staff into those specialist teams! Our Members are certainly well aware that morale is low among many CMHTs not least because their staff feel left out of the "sexier" new services which are more likely to attract resources. The Assembly Government is also looking at the role of the Teams but I am not sure that the key challenge of constructing an integrated community mental health service is being addressed nor the pressing need to respect and, yes, expect much more of the CMHT function.

I can’t conclude this point without reference to a yet more fundamental matter. All such community (and indeed in-patient) services need to be subordinate to the individual care plans of clients who should have maximum control over choosing – or indeed commissioning – a bespoke package of holistic treatment and care designed for them personally: see here what users want.

How to form a new government

Sunday lunch with friends staying near Strumble Head on the wild North coast of Pembroke-shire, followed by a walk East in bright sunshine but blasted by a cold North wind to Carregwastad (picture). This inhospitable, harbourless wilderness where open sea smashes onto the rocks has a contemporary relevance, offering a different approach to changing government in contrast to the current negotiations in London. At this desolate place the forces of revolutionary France landed in 1797 to foment an uprising by the oppressed and mainly disenfranchised population of these islands against the British sovereign and Parliament: my guide old friend Neil Matthew off duty from the Countryside Commission for Wales shows me the monument commemorating the invasion (picture).
This approach of encouraging liberation movements with an injection of military support worked quite well for the French elsewhere in Europe and they will have been encouraged by the expressions of sympathy for their Revolution by many in the Romantic Movement, then a significant voice among the chattering classes in Britain. In the event the invaders' sole act of liberation was to free a vast quantity of Portuguese wine, leading to a much too early celebration of success; within 48 hours the hangover had set in and they surrendered. And what of the local population? Had they been ready to accept their continental brothers' assistance and rise up to throw off their chains? The mainly well-healed Romantics will have been disappointed to learn that in fact the locals (including the legendary Jemima Nicholas) poured into threatened Fishguard unbidden to assist in its defence. We hope that two centuries later and many miles away in Westminster Nick, Dave, and Gordon will work out a more successful way to establish a new government.

1974 And All That

My earliest political recollections include the Carmarthen by-election in 1966 - but I didn't really understand what that was all about - and then Ted Heath's one General Election victory: the evidently Tory matron at my preparatory school joyfully announced the surprise Conservative win as she switched on the lights in the gloomy damp hangar they laughably called a dormitory early morning on 19 June 1970. Her message fell on deaf ears: as inmates of this Gulag for children of the middle classes we were only interested in day-to-day survival (raiding the kitchen for midnight feasts after lights out, for example). I was a bit more engaged by the time of the first 1974 election and recollect Heath trying to do a deal with the Liberals who wanted too high a price in electoral reform. I suppose that the outcome then, minority government by the former opposition, is quite likely now (and perhaps Cameron would call another election this Autumn like Wilson in '74): however, don't rule out a Lib-Lab coalition. But enough speculation! We will find out soon no doubt.

Either way given the hung Parliament there are some conclusions you might already draw about implications for public services including mental health. In these circumstances no permutation of government is going to be inclined or able to make unpopular decisions easily and this may delay major cuts in public services for longer than otherwise though the consensus is they will come eventually and they will be severe. Whether this delay is a good thing is for each of us to judge, but those of us who campaign for and provide mental health services will need to keep up our guard.

On the other hand I will eat my hat if VAT doesn't go up, however unpopular that may be.

A Capital Event

I attend the first of 22 County events in our “Road to Recovery” campaign at Hafal’s National Resource Centre in Cardiff. The rain holds off most of the time and nearly 100 people call in to see the microbus and learn more about the key messages.



I am delighted to see all four touch-screen computers mounted in the bus are in constant use as guests check out the principles of mental health recovery (link here) and the campaign itinerary (link here). Junaid Iqbal handles the barbecue expertly: assisted by staff and volunteers everybody gets a substantial and healthy meal without tedious queuing. Fred Dymott, improbably dressed as a flower person circa 1967, sells a huge quantity of garden produce from Hafal’s horticultural project adjacent to the Centre, including a carful of bedding plants for me. Hafal Chair Elin Jones does a professional job of the S4C interview; she then pops out momentarily to St. Fagan’s legendary bakery and very kindly gives me a loaf (half of which I disgracefully devour during the drive back – well, it was still warm and the smell...).



A good crowd from Hafal’s carer group join service-users at the Centre: over 70 sign up on the campaign message calling for:-

- A new Welsh law (Measure) which gives priority to timely treatment and comprehensive care planning.
- All mental health services to be developed and delivered in response to individuals' care plans.
- New resources to bring mental health services up to scratch.

The Cardiff crowd also has plenty to say about the replacement of Whitchurch Hospital and the future of community-based mental health services in the city: see this link for more pictures and the full message sent from Cardiff as an "e-postcard" to the movers and shakers.

Nobody mentions the election but there is a fin de siecle atmosphere in the sunshine and warm Spring rain - whatever the result somehow from tomorrow things will never be the same again...

6 May - The Big Day

Everybody agrees that events this Thursday will have enormous significance for the future of Wales and all eyes will be on the results. I refer of course to the first stop on Hafal’s “Road to Recovery” campaign when the microbus will be centre-stage at Hafal’s Cardiff event at our National Resource Centre in St. Fagan’s: I have accepted my invitation from Hafal Cardiff's Junaid Iqbal (second from left in the picture) and look forward to a fun and informative day. When we planned the 22 events (link here for details) we guessed that 6 May might coincide with the sideshow of a General Election but calculated that the public and media might be engaged by something different being aired on the day. Polling day is always strangely calm: the politicians have finished making their case and are resigned to their fates while the voters have no reason to make a big show of visiting the polling station (those who did not avail themselves of a postal vote – incidentally, am I alone in finding the postal vote instructions almost incomprehensible?). Anyway, the calculation seems to have paid off as we have a big crowd attending along with television and other media – more about that on Friday. Meanwhile let me pay tribute to Hafal’s members in Cardiff: we have always had an active membership, in the past mostly carers but now also many service-users. In addition to supporting each other and Hafal’s services our Cardiff members have never shrunk from putting their case for improving mental health services in the city, engaging patiently but assertively with the sometimes Byzantine consultation arrangements. In particular our Members have been involved for some years in the process of replacing Whitchurch hospital only to see the plans shelved recently. There probably is a case to review the plans but please let there be timely and effective consultation: if commissioners sat down with an open mind to work this out with Hafal’s Members and other customers I am sure a good conclusion could be reached. I know I will get my ear bent about this on Thursday....

Catiline

Celebrity classicists Mary Beard and Boris Johnson talk on Radio 4 news this morning about the similarities between elections today and those in the first century BC. In passing Boris mentions Catiline (Lucius Sergius Catilina if you want to be pedantic) but not the details of how he narrowly failed to win popular support and take control of the Roman government in 63BC on a ticket of debt cancellation. Like today a large proportion of the population had borrowed heavily in a boom and then got into greater debt as the inevitable bust followed: these disgruntled citizens, blaming everybody but themselves, were enticed to support Catiline by the revolutionary concept of cancelling private debt. The similarity had first occurred to me when the bank crisis struck last year and there were then some desperate voices suggesting cancellation of substantial personal debts as a way of stimulating movement in the economy. However, no serious political party has sought votes on this basis. For the record Catiline saw his political ambitions thwarted by the rhetorical skills of Cicero, a surprise to me and fellow students of the tortuous logic and unfunny witticisms of the sadly extant "In Catilinam" speeches (see picture of this schoolboy's translation nightmare banging on in the Senate). No doubt equally unimpressed Catiline raised a great army of debtors, took to the field, and was crushed by the creditors' forces; observing that his novel economic policy was in tatters he died bravely in the front line. We trust that the results of this Thursday's election will be respected peaceably by all sides.

May Day May Day

During this welcome Bank Holiday weekend I stumble upon a new installation on Swansea Bay next to County Hall: artist Jackie Chettur has positioned a series of 3-D viewers (see my picture) facing out to sea. At first sight this looks like just a curious sculpture - and it is that - but on closer inspection every viewer contains a seascape created with old post-cards, models of ships, etc, photographed stereoscopically to create dramatic events, including fires at sea, storms, and exotic locations during a nineteenth century clipper's voyage from Swansea to Chile to collect copper ore. Authentic quotations from mariners' logs are attached to each viewer to create a startlingly vivid story. I notice that many people are too embarrassed to look through the viewers, the exception being those with children who of course insist on looking and enjoy the story. You can see a couple of examples on the artist's website although of course these don't give the 3-D effect. Good fun - see it until 23 May.