Festive Horror

So that was Christmas and we now face the long haul through to the spring. It is sobering to contemplate that it will not really be warm enough to plant out a marrow seedling until June - nearly six months away, for heaven's sake. However, I draw comfort from the fact that, even though the worst of the winter weather is likely yet to come, you can already see the days lengthening!

My picture above shows the gloomy reality of these shortest of days taken at 3.40pm while I was exiled from the house as the recording of Downton Abbey was played back. Because that festive horror was so long I had time to penetrate far into the woods and take this snap earlier on the walk...



...it doesn't look like much but actually there are about forty deer in the picture as you can just see from this blurry close-up...



Having avoided Downton I decide to give its writer Julian Fellowes another chance by watching his 2009 film "The Young Victoria" which is on the box. The actors do their best but can't make anything worthwhile out of the wooden script which patronises the audience by oversimplifying the subtle development of the young queen.

Her real passion for young Albert, which was truly a great romance, becomes voyeuristic and banal in this film. But the final straw comes when Albert is gunned down by a would-be regicide so that young Vic can nurse him back to health. This of course just didn't happen as the attacker missed completely and the royal couple were unhurt. The writer evidently felt he needed to spice up his plodding plot but in fact the story could have been much more exciting if based on the true story - but it would have to have been well-written.

There is a valuable story about mental illness here too. The assailant with the gun was Edward Oxford who was apprehended immediately and you might have expected him to be harshly treated for his offence. But the 1840 court looked at the case carefully and concluded that he was not guilty because he was mentally ill. He was locked up in hospital but treated well. He was released from Broadmoor some years later and went abroad to make a decent life for himself. There is little doubt that he would have been treated worse today (I mean in judicial terms), between the predictable hysteria about the monarchy and the merciless refusal of the modern justice system to accept that mental illness can be a clear and full defence (see this post).

Dave the Slave

Happy Christmas! That's for everybody but a special mention for Hafal Members and others with experience of serious mental illness and for Hafal staff and volunteers working today.

A year ago I mentioned the publication at the same moment as the first Christmas 2010 years ago of Ovid's Ars Amatoria. It occurs to me that it would be appropriate to note how the seasonal festivities were being celebrated across the Roman Empire at that same time.

No, I haven't had a chronological brainstorm. It was customary 2011 years ago for citizens to attend a carol service with readings, go home and exchange presents, and then overindulge in food and drink in an age-old celebration of the birth of the state religion embracing rich and poor alike. I refer to the annual Saturnalia which culminated in late December and dated back some further hundreds of years. The carol service was at the temple of Saturn but otherwise the whole festival would have been recognisable to us today.

One distinctive feature was a role reversal where masters waited on servants or slaves (a custom which persists in some aristocratic contexts today). There are a few reports of this curious activity from antiquity and, if you listen very carefully, you can even hear the slave's point of view from all those years ago...

The poet Horace's slave Davus (let's call him Dave) got his say one Saturnalia two thousand years ago, getting permission from the famous Augustan poet ("Use the licence granted by our ancestors each December to say what you want") to retaliate after years of listening to his master boasting, whinging and pontificating to his friends at dinner parties. Among many well-judged accusations of inconsistency and hypocrisy Dave offers these (my loose translation from Satires 2.7):-

• You constantly complain that everything was better in the good old days "when men were men" but if you actually had to live then you wouldn't have been able to survive.

• When you are in town you go on and on about how much better the country is...and vice-versa.

• If you haven't had any invitations to parties you bang on defensively about how you prefer your own company and the simple life at home but, if you actually get an invite from a rich friend, you charge around hysterically shouting at us to get your clothes ready to go out.

• You scoff at my simple love life with a lady of the night from down the road but what about your furtive affair with a married woman? And who is the slave here when you have to run around meeting her every unreasonable whim?

• In summary, how sure are you that you are worth more than the 500 Drachmas you paid for me?

At this point Horace shut him up forcibly, threatening violence and regretting ever letting Dave speak his mind. Specifically Horace threatened Dave with transfer to work in the fields of his farm in the country - away from his girlfriend and no doubt a lot harder than serving as a butler in the poet's town house. But...

...in fact Horace was a decent chap, the product of the surprising social mobility of those days - his father was a freed slave - and he enjoyed a relaxed and friendly relationship with his servants both in Rome and at his little Sabine farm (pictured in winter above).



Postscript:

What's a Greek urn? About two Drachmas a week. More to the point how much is 500 Drachmas? Dave was evidently a Greek as he refers to Drachmas but a Drachma was essentially the same as four Roman Sesterces. 2,000 Sesterces wasn't a lot for a slave (a healthy girl might fetch 8,000) but was still twice the annual salary of a soldier (who would be a Roman Citizen). But that wasn't a great deal - they signed on for the adventure and to escape grinding poverty. Maybe the best point of reference would be the price of the local wine which Horace - and undoubtedly Dave - would have been drinking at the time of their little exchange. It cost about one Sesterce a litre so Dave was worth about £10,000 in today's money.

Running Dogs of Capitalism

Not all the actions of the brutal North Korean dictator Kim Jong-il who died today were absurd. In particular I note that he put the Welsh King of England Henry VII's portrait on one of his postage stamps - something not yet done in the UK in spite of the wily old usurper's canny construction of the modern state, ending the chaotic Mediaeval era decisively by imposing systematic taxation and central control of the legal system.

The first Tudor is overshadowed by his son Henry VIII but deserves much more attention. His claim to the English throne was tenuous in the extreme, partly relying on his grandfather's's marriage to the widow of Henry V but more especially on his mum (Lady Margaret Beaufort, a dour evangelical who founded my College among other good works) who descended from an illegitimate son of John of Gaunt - so, you are right to be puzzled, he had no serious legal claim.

In fact he probably had a better dynastic case, based on relationships with several Welsh princely houses, for being the last plausible "Mab Darogan", the mystical "Son of Destiny" awaited by optimistic Welsh people with a mission to expel the Anglo-Saxons from these islands, following in the footsteps of King Arthur and Owain Glyndŵr.

Indeed he made much of this when he landed in Milford Haven, raised the banner of legendary 7C Welsh King Cadwaladr, and went on to thrash Richard III at Bosworth with many Welsh soldiers in his army including Carmarthenshire hard-case Rhys ap Thomas who struck the infanticidal last of the Yorkists dead with his pole-axe as he was looking for a horse. Henry even called his first son Arthur in the spirit of redeeming Welsh honour but of course the lad died young leaving his widow Catherine of Aragon second-hand (and so contrary to the Book of Leviticus) to his younger brother...the rest is (more familiar) history.

By coincidence I am presently reading the first substantial biography of Henry for many years The Winter King which my Mum has given me for Christmas (I couldn't resist opening it before the big day). It's looking good, offering a balanced view of the old chancer whom I can't help liking.

The Korean stamp (above) uses the best portrait of the monarch in the National Portrait Gallery which is unusually life-like for its time (and seemingly accurate - it compares very closely with his death mask). He looks like what he was: cunning, pragmatic, anti-war but prepared to fight for his own, and intelligent, a contrast to his son's pompous and megalomaniacal portraits and those of many of his dim royal successors. He also looks like a particular type of Welshman with his thin face and narrow, inquisitive nose - a bit like the late, great comedian and crooner from up the road in Ammanford Ryan Davies (see below).

If you are wondering why the North Koreans put Harri Tudur on their stamp then I'm afraid I have no idea. Maybe Kim thought that Henry's successful thwarting of rebellions led by those running dogs of capitalism Lambert Simnel and Perkin Warbeck would send a message to anybody thinking about questioning his position? On the other hand it is difficult to imagine Kim treating a rebel as Henry did Simnel: the generous king pardoned him and put him on a rehabilitative work scheme - turning the spit in the royal kitchen.

Meretricious Tosh

Can mental illness inspire great art? This was not a matter I meant to address when I went to Cardiff yesterday but, while Mrs Blog completed the Christmas shopping, I popped into the National Museum to look at a temporary exhibition of David Jones (1895 - 1974) and the question got an answer of sorts.

Welsh visual arts in modern times have mostly comprised soulless, homoerotic or Soviet-style schlock portraits of the "heroic working man", equally soulless and alienating landscapes often including barbed wire, and some third-rate conceptual projects. Boring!

Jones is an exception. His watercolours and occasional oils show intimacy with the Welsh landscape, inviting your engagement and exploration. He has a unique and instantly recognisable style which merges drawing and painting in a striking way. And he uses colour freely to convey mood, delightfully unconcerned with realism.



And yet...

Jones is not a great painter. He got bogged down with spiritual and mythic stuff which lost him valuable focus on simple themes. His work does not develop over his career. In short his pictures all look like the early work of a very great artist. Jones' poetry similarly showed great promise but that promise was never fulfilled.

Why is that? The answer seems to lie in Jones' service with the Royal Welch Fusiliers, in particular at Mametz Wood, where an entire division of Welsh volunteers with no experience and worse equipment and leadership fought for five grim days during the Battle of the Somme (1916).

It is said that many who served in the First World War lost their youthful innocence in the carnage and came home older than their years. But horrible suffering doesn't help young people grow up. It was a common experience in the forward positions on the Western Front to hear wounded and dying comrades crying out to their mothers to come and help them. Many never grew old because they died there but many others were unable to move their lives forward into maturity because they were traumatised by their experience.

Jones came out severely damaged. He clung to his parents who helped as best they could; he sought out father figures like the sculptor and typographer Eric Gill; he had several break-downs and spent long periods unable to work at all; he could not relate successfully to women, causing him life-long unhappiness (he several times illustrates sexuality as a woman lifting her skirt coyly - surely the product of an Edwardian school-boy's imagination not that of an adult?); like others trying to come to terms with their war-time experience he turned to a half-baked spirituality; and photographs of him in old age show a mixture of anguish and boyish innocence.

Great art requires groundedness and accurate and truthful observation, things which mental illness obstructs. This doesn't mean that people who experience mental illness can't be great artists: Vincent van Gogh proves that point but then he was clear that his illness was a hindrance not a help (see this post).



Postscript:

Following these sombre reflections and a satisfactory ingestion of raw fish at Yo Sushi we use the Orange Wednesday 2 for 1 deal to see the new flick "My Week With Marilyn" about the making of the feeble and lumbering comedy "The Prince and the Showgirl" (1957). This is based on Colin Clark's highly suspect "memoir" of working with Ms Munroe in which we are asked to believe that she relied heavily on his moral support and intimate friendship. She goes skinny-dipping with him and lets him sleep in her bed - chastely we are relieved to observe because otherwise this adolescent fantasy would have gone too far.

Young Colin's job was actually to fetch tea for Laurence Olivier and the other actors and I doubt he got more than a few polite "thank yous" from the then Mrs Arthur Miller. I suppose he was jealous of his older brother naughty Tory grandee Alan Clark about whom you just couldn't make it up (see this post). The film is meretricious tosh but quite fun for all that.

Earthy and Graphic

I am on holiday and refusing to write about mental health...



My old employer Swansea Sound's weather lady got it right this morning as I heard while running in the gym: "I'm sorry but I can't sugar-coat it - the weather's going to be AWFUL". I found out how right she was when I went outside to swim. And they hadn't put the cover on the pool last night so it had virtually frozen. Is this neglect because ubiquitous smiling beardie and inexplicably popular hippy-capitalist Richard Branson recently took it over? The staff are too busy painting everything red.

The water was bitterly cold on the first length but it got worse as I swam back, this time right into the 50 mph wind which blinded me with a blast of hail. I recuperated in the Jacuzzi feeling I had earned a bacon sandwich at Forte's in Bracelet Bay where I head after mooching for a couple of hours in Swansea town centre.

The sea looks quite calm in Swansea Bay but as I turned the corner past the twin rocks of Mumbles head I could see the rolling high seas beyond. Very cosy eating my lunch with a hot cuppa while looking out on the storm through this old Italian caff's picture window.

Time to reflect that Mumbles is of course so named after the two above-mentioned, breast-like rocks - possibly from the French "mamelles" or Latin "mammillae" but I think from an older Celtic coinage - you won't find a more universal root than this onomatopoeic representation of breast-feeding. We can only hope that Thomas Bowdler, the infamous and much-ridiculed censor of Shakespeare who lived here for much of his life, was unaware of this etymology and so went about his business unembarrassed in the village.



My favourite bowdlerising is in Iago's report in Othello (Act I, Scene I) transforming "I am one, sir, that comes to tell you, your daughter and the Moor are now making the beast with two backs" (Shakespeare) to "...your daughter and the Moor are now together" (Bowdler's "The Family Shakespeare"). Nothing could better illustrate the contrast between the earthy and graphic Elizabethans and the (somehow grubbier?) 19C prudery - so much is conveyed in that coy evasion "together".

Sarky Celebs

I'm off on holiday at the end of this week until the new year - catching up with holidays not taken because of my time-(mis)management during the year. I had thought of jetting off to warmer climes but finally agreed with Mrs Blog that we'd rather stay at home and chew the fat. In the teeth of my grumpy and sociopathic tendencies Mrs B has organised or agreed to a series of social events through the festive season which is no doubt better for me than holing up with a book or three for the duration which would be my first instinct.

I give notice that I'm not going to post any worky blogs now until 2012 as I have found, perhaps unsurprisingly, that doing this when I'm off duty does tend to drag my attention back onto professional matters at the expense of the fun and games which should be the order of the day when you are on holiday. It's a "work-life balance" matter - though I hate that term as it implies that work is not a part of your life which is a rather sad way of looking at it, even if on a bad day it might feel that life doesn't begin until 5pm!

I think I might also have to stop watching the news in order to lower my blood pressure. It is not raised by the international financial crisis so much as by the cynical parade of sarky celebs attending the Leveson Inquiry in order to whinge about press intrusion. We are being softened up by these egotists and by the politicians (the most vocal of whom seem to have had their own embarrassments with the press over expenses and other matters they'd prefer us not to know about) for significant restrictions on freedom of speech.

In fact the excesses of the press such as phone-tapping, belligerent door-stepping, and buying information from the police are matters for which there are already legal remedies - they are crimes. If anything we need to take action to protect freedom of speech in the light of the outrageous use by the rich and powerful of super-injunctions and libel laws to shut people up (remember Bob Maxwell?).

Freedom of speech is vital to the protection of poor and vulnerable people - not least people with a mental illness - because the bullies and scoundrels who would like to exploit them are fearful of exposure. In return for this it is a small price to pay if the occasional wealthy film-star or sports supremo is put off his breakfast by some tittle tattle in the paper about his private peccadilloes.

Satirical

The Office for National Statistics has cheered everybody up today by publishing the first official study into how happy we are (see the story here). This works in two ways. People who take the study seriously take heart at the fact that three-quarters of us seem pretty happy thank you very much; the rest who think it's a pointless farce for the government to spend money in this way are enjoying satirically the fatuous commentary and daft conclusions being drawn by pundits from these meaningless statistics.

Individual citizens know much better than government what happiness really means to them and would prefer to be left to work things out for themselves. Least of all do citizens need mental health organisations (yes, including Hafal) to start telling them how to be happy; and government would do better to concentrate on its duty to assist those who really need help by reason of their mental illness.

We already have a potent means of telling politicians whether we are happy - through the ballot box. Meanwhile we should all take time to share with each other what makes us happy and to start the ball rolling I will mention squid tempura, fried foie gras slices with piquant cold pickle, and this. I'm not proud.

Justice v Fairness

The preliminary psychiatric assessment of Anders Breivik, the Norwegian who has admitted killing 77 people last July, has been published to mixed reactions. As discussed in a previous post (see here) it is important for mental health service users and their families to consider these events carefully because, like it or not, the British public will draw conclusions from the case about the nature of mental illness and what should be done about it.

Some people in Norway are dismayed that he may not stand trial as he was suffering from paranoid schizophrenia. Others, including some relatives of victims, have made measured comments about it not being so important how the illness is seen legally as it is to ensure that the public is protected from him in future.

The case is perhaps most interesting to us in drawing out statements about the system in the UK and I was particularly struck by the comments from Richard Charlton, chairman of the Mental Health Lawyers Association, which relate to the points I made in my previous post on this. He reports that he has represented people who have killed other people believing they are saving them from the devil, but courts have not found them to be insane.

He explains that if the patient knew that killing was wrong, even if God told them to do it, then that's not enough to give them a defence of insanity although it might be sufficient to give them a diminished responsibility defence (which, as the term implies, still means that the person is held significantly responsible). Insanity requires a higher test, and one example he offers is somebody who throws a baby onto a fire in the belief that the baby was a piece of wood and not a baby.

When you consider this it is actually not a fair test because it can convict a person who acts from good (but deluded) intentions and therefore there but for the grace of God go many decent people who might sadly experience a serious mental illness in the future. A police officer who shoots a suspect who points a replica gun at him properly has a defence even though (i) he was deluded because there was in fact no danger and (ii) he knows that killing people is generally wrong: the point is that the police officer acted with good intentions.

The truth is that, as my late father (a lawyer) told me years ago, the justice system is not really fair at all in spite of the rhetoric of some high-minded lawyers and philosophers. In practice justice is a compromise between fairness and expediency - the latter being based on what politicians believe the public will bear. And politicians don't think that the public will tolerate not holding people responsible for their actions even though in practice they had no control or realistic choice over those actions.

The consequence is that patients are blamed for actions over which they had no control whereas they might have been detained for reasons of public protection but at least meanwhile been allowed to establish their innocence by reason of insanity and thereby gained some compassion from society.

This isn't going to change in a hurry but we must be prepared to engage in thoughtful debate. It may be said that following events like those in Norway isn't the best moment to have that debate but I'm afraid the debate is happening as I write, in the British media and in pubs and clubs up and down the country.

Tricorn Hats and Bodices

Take a look at Hafal's latest briefing for Assembly Members here which gives a good summary of the key current issues for mental health in Wales, namely...

The Mental Health (Care Coordination and Care and
Treatment Planning) (Wales) Regulations 2011 - more or less a done deal but requiring National Assembly sign-off (due today but delayed as business is disrupted by tomorrow's strike)

The Code of Practice for Parts 2 and 3 of the Measure - currently subject to formal consultation.

The new Mental Health Strategy for Wales - currently being drafted by officials.




Postscript:

My brother Skypes to tell me that the Picton trial (see my last post) featured on telly last night in "Garrow's Law" (I've never seen it but apparently it's a sort of low-rent legal version of Tom Jones - all tricorn hats and bodices) but they got the century wrong and, more disturbingly, the result, oddly neglecting to report the retrial where he got off! Artistic licence is one thing but if you are purporting to reflect real events this is rather misleading - and a reminder to trust reliable sources like this Blog rather than the BBC. Anyway here he is dying at Waterloo...

Brutish and Uncompromising

A relaxing weekend catching up with the world beyond Hafal. I have previously commented on the phenomenon of people objecting to the celebration of historical characters because they are found to be wanting by modern standards (see here). The latest manifestation of this is a campaign to remove a portrait of Waterloo hero Sir Thomas Picton from the courtroom in Carmarthen on the grounds that he was prosecuted for torture when he was governor of Trinidad.

Actually he was found not guilty (so you'd think that the lawyers objecting to the picture might respect that verdict?) but in truth attempting to defend Picton on any test of modern moral scruples is a completely hopeless proposition. He was a brutish and uncompromising soldier who would have snorted with derision at this spat.

But the most interesting thing about the Picton trial was that it took place at all. Contrary to many modern assumptions the rule of law did matter then (1808) and it could be used to protect the most humble people from oppression by the most powerful. In this case Picton was prosecuted for allowing the torture of a young mulatto girl suspected of theft who was made to stand on one toe for up to an hour on two occasions - certainly a nasty experience but small potatoes compared with practices found to have been used in our name in recent conflicts. He only got off on appeal because he persuaded the court that Spanish law (which permitted all kinds of excesses) applied on the island as British law hadn't yet been formally adopted - a neat lawyerly defence.

It is commonplace to sneer at our predecessors for barbarism and injustice but can you imagine today's senior British military commanders being seriously held to account for mistreatment of suspects abroad which falls short of death or even injury? In fact little has been done about much worse behaviour, a measure of our moral degradation and disrespect for people of other cultures.

Landmark Moment

Time to reflect on the great news that mental health service users in Wales have won the legal right to holistic care plans. Years of campaigning by service users and carers have resulted in new Regulations which give patients in Wales the right to a Care and Treatment Plan covering all areas of life.

The new rights to holistic care planning have been set out in the Regulations for the Mental Health (Wales) Measure which were laid before the Assembly two weeks ago. The Regulations, which cover Care Coordination and Care and Treatment Planning, set out what professionals must do in order to deliver the new Welsh mental health law which comes into effect in 2012. The Regulations are now subject to the approval of the National Assembly on 29th November.

As Dave Smith, Hafal's Expert Patient Trainer, explains:

"The Regulations prescribe a comprehensive Care and Treatment Plan which covers eight areas of life, and they are accompanied by a template which clearly provides a space to address each of these important aspects of recovery in a holistic way.

"This has the potential to transform the service provided to people with a serious mental illness in Wales. It means that all secondary mental health service users will have a legal right to a Plan with spaces for all areas of life to be addressed ensuring that important issues such as accommodation, employment and physical health are covered in their Plans.

"Hafal Members have campaigned for years for the legal right to a comprehensive Plan so to have such a Plan prescribed in law is a massive victory. It’s truly a landmark moment for service users in Wales."

A reminder of the eight "life areas" to be covered in Care and Treatment Plans...

a) accommodation

b) education and training

c) finance and money

d) medical and other forms of treatment, including psychological interventions

e) parenting or caring relationships

f) personal care and physical well-being

g) social, cultural or spiritual

h) work and occupation.


Hafal’s Members pioneered this methodical, holistic approach to recovery from serious mental illness which was based on the experiences of hundreds of people and we published our methodology six years ago. This holistic approach was then rolled out through Hafal’s projects across Wales, resulting in remarkable recovery successes for Hafal’s clients.

Following the organisation’s adoption of the recovery model Hafal’s Members continued to campaign for the adoption of this model across Wales for all secondary mental health service users, and successfully lobbied for the creation of a mental health law in Wales.

The Assembly Member who initiated the new mental health legislation, Jonathan Morgan, said that the most convincing evidence for reform came from listening to the story of service user and Hafal Recovery Practitioner Lee McCabe. More recently, speaking about the Regulations, Lee commented:

"When the Regulations were published in draft it wasn’t made clear that the Care and Treatment Plan would need to include space to address all the eight life areas. Hafal launched a massive user-led campaign which was supported by hundreds of service users and carers across Wales to ensure that the eight areas are clearly given space in the Plans. We are very pleased the Government has listened to our standpoint and amended the Regulations to give proper prominence to the eight life areas."

It is to the credit of the Welsh Government that they listened to Hafal’s Members when we called for a Welsh law and latterly that they took on board the need to include the eight life areas explicitly in Care and Treatment Plans.

The next step is to achieve a robust Code of Practice which prescribes in more detail how health professionals will deliver the Measure; the first draft was published last month and service users feel that it needs to be improved to ensure that the eight areas of the Care and Treatment Plan are routinely addressed, that psychological therapy options are always covered, and that there are clear timescales for agreeing Care Plans.

Of course when the Measure comes into effect in June 2012 it doesn’t mean that it will solve all problems and guarantee a good service. But for the first time it will provide a solid platform of care planning so that people’s needs will be properly assessed and recorded and the required actions agreed with them. From this basis we can build great mental health services and help more people achieve recovery and become fully engaged in society, be economically active, and lead rewarding lives.

Chicken-Sitting

I am enjoying a long weekend looking after my brother's livestock out west and taking the opportunity to check out places of interest which I haven't seen before.

Today we head off to Cilgerran Castle en route to Cardigan market. Best known for its scenic position it's fairly run of the mill as castles go but famous for a notorious Christmas party in 1109 which got seriously out of hand when Nest, daughter of Rhys the last king of Deheubarth and wife of a Norman carpet-bagger called Gerald de Windsor, got carried off by local bad boy Owain ap Cadwgan. Or was she seduced and went willingly? Or was it a secret Welsh plot to get her away from her in-laws and start some trouble?

The arguments still rage in obscure Mediaevalist circles but I would just make the observation that Nest seems to have been the ancestress of a sizeable proportion of both the Welsh and Norman aristocracy having put herself about - or been put about, let's stay neutral on this - with everybody from Henry I downwards (the king's son by Nest was Henry Fitzroy or Fitzhenry). What everybody seems to agree is that she must have been the greatest beauty of her era, a veritable Welsh Helen of Troy - shame there are no pictures.

By way of contrast I take a look at the little-known church of Bayvil just a mile east of Nevern church which is itself famous for its Celtic Cross, bleeding yew, Ogham inscriptions, etc. In fact I suspect that Nevern's fame may account for Bayvil's uniqueness as a perfect example of a late Georgian church unnoticed and so unruffled by Victorian meddlers who probably thought it too new and too boring to spruce up and so concentrated on its glamorous neighbour.

As you can see from my picture it is ultra-simple, in-your-face low-church, and dominated by a pulpit which allows the preacher to lean right over his flock and inculcate the Word without any idolatrous distractions. The only symbol in view (and it isn't really a symbol at all but clearly symbolic) is the vast bier for bearing the coffins of deceased parishioners which is stored in full view below the pulpit - an entirely practical arrangement (where else could it go?) but no fancy icon, painting, or statuary could provide a starker memento mori to any member of the congregation whose thoughts might otherwise wander (Lord preserve us!) into a day-dream about the deeds of Princess Nest...

Shifty-Looking Rogue

I'm catching up with the pictures from our record-breaking conference last week which saw over 200 eager participants making their way to Builth Wells from all parts of Wales - and they definitely had a good time as we score nine out of ten in the evaluation, also I think a record although we do get consistently good marks for our events thanks to the tireless effort of the organisers and a lot of care taken on the day with our guests who include many very vulnerable people for whom the day is quite a challenge. It was great to see a lot of new faces from new services which we have developed since last year in the teeth of the financial squeeze.

The most popular side-show of the day was the paint job on our life-size model VW camper (the real thing was just outside though represented indoors by our surreal camper tent visible in the picture above).

There is some discussion about the identity of the driver painted in the left-hand seat (correctly - it is left-hand drive), a shifty-looking, crop-haired rogue in a Hafal tee-shirt peering over Tesco Value glasses. Later in the day someone adds a halo which is confusing.





As last year the most stressful part of my day was not Hafal's AGM which passes off in swift good order but the "Camper Cookery Master Class" in which I pretend to prepare a three course meal while our bomb-proof Company Sec Nicola Thomas does the real work, impressively managing not to get food on her posh red sari.

This year we knock out smoked mackerel paté, pitta pockets with griddled beef and mixed vegetables plus couscous, and fresh pineapple with cream and a cherry highlight.

It's all going quite well until I attack the pineapple with a knife and, regretting my failure to practise beforehand, I slash aimlessly at the fruit and in the panic my specs fall off into the sticky juice (luckily they are just Tesco Value ones - a snip at £10 including prescription lenses).

All Aboard!

I'm looking forward to Hafal's "All Aboard!" Autumn Rally in Builth Wells this Thursday which is set to break all records with a massive attendance. Hafal Events Coordinator Emma Billings tells me:

"Two hundred delegates have already booked to attend the Rally and the aim is both to offer an opportunity to network and also to explore the challenges faced by people recovering from serious mental illness. This will be a lively event, with different areas for those attending to visit and enjoy throughout the day."

Highlights include:

• "Taking the Wheel" - celebrating the success of the 2011 campaign run by service users with support from Hafal, the Mental Health Foundation and MDF the Bipolar Organisation Cymru.

• The Exhibition Station - an interactive exhibition showcasing Hafal's work across the 22 counties of Wales.

• The Learning Centre - opportunities to meet our team of Expert Patient Trainers, talk to colleagues from Wales' new National Centre for Mental Health and Bipolar Disorder Research Network, get advice and guidance about IT, learning, employment, housing issues and criminal justice, and pick up a range of new publications, FREE of charge.

• Art Corner - getting creative and helping us give our giant model VW camper a paint job!

Emma adds:

"We will also hold our annual meeting specifically for users, as well as an important meeting of the All-Wales Mental Health Carers' Forum - which offers visitors a special opportunity to network with families from across Wales."

As usual I have been unnecessarily poking my nose into the preparations but must resolve to back off and leave it to Emma and her many assistants.

Time-Torn

A weekend of sunshine lets me get the bike out for a spin around the Swansea corniche followed by lunch al fresco in the marina - it could easily be Biarritz except I make do with a bacon bap instead of a plateau de fruits de mer and a pot of tea rather than a crisp sauvignon blanc. Not that much like Biarritz then.

Later, on a walk back inland, I discover a curious fungus (not edible) on a dead tree which appears to offer stereo sound (picture below).

Meanwhile in the long evenings since the hour change I've been reading Claire Tomalin's Thomas Hardy The Time-Torn Man. I recommend it as she makes the old melancholic come alive and doesn't bore on with too much literary criticism like so many biographies of writers.

I like Hardy's poetry best and struggle with his novels ever since reading the Woodlanders which starts with 40 pages describing how to whittle sticks in order to make hurdles (whatever they may be). I think the idea was to convey the tedious monotony of country life for the poor and in that it certainly succeeded but at some risk to the reader's patience.

I was reading how Hardy twice interviewed veterans of Waterloo in preparation for a project (the unreadable Dynasts epic) when by chance I heard on the radio that an actress called Norrie Woodhall who knew Hardy well has just died aged 104. It is surprising how closely linked we are to events which otherwise seem distantly historical. Sometimes these links matter, for example in the case of Marshal Pétain who infamously persuaded France to surrender and collaborate with Hitler: as a child he had been enthralled by the stories of an ancient uncle who had also fought at Waterloo (in 1815 for heaven's sake!) and taught him to hate the British...

Business Everywhere

Apologies for the the long gap between posts. I was in North Wales for the latter half of last week and the Orange "Business Everywhere" plug-in stick didn't live up to its name meaningfully in room 207 of the Colwyn Bay Travelodge. I did try but felt like the telegraph officer on the Titanic attempting to transmit letter by letter with a desperately slow connection (well I suppose he was more anxious than I was).

Anyway, the important news is that Lee McCabe has now published his campaign on the Code of Practice for Parts 2 & 3 of the Mental Health Measure. This sounds boring and technical but don't stop reading! Honestly, this Code sets out in practical terms how Care and Treatment Plans must be developed for all users of secondary mental health service. It may therefore be even more important than the new Mental Health Strategy currently being written.

One of the three issues that Lee raises is about timescales, both:

● from referral by a GP for assessment for secondary mental health services
to that assessment being carried out; and

● from assessment as a "relevant patient” (needing secondary mental
health services) to the completion of the required Care and Treatment Plan.

There is guidance on assessment timescales under part 8.9 of the draft Code
but this relates to Part 3 (which concerns former users of secondary mental
health services) and it is not mentioned in relation to Part 2 (which concerns
care planning).

The timescale for getting assessments done needs to follow the Welsh Government's own timescales for assessment set out in its interim community mental health team guidance which says that:

- Emergency referrals will be seen within 1-4 hours;
- Urgent referrals will be seen within 48 hours;
- Routine referrals will be seen within a maximum of 4 weeks, but usually much sooner.

And there should be clear deadlines for the creation of Care and Treatment Plans following assessment as a “relevant patient”. Lee suggests:

- Plans must be created a maximum of 6 weeks from assessment under most circumstances
- Plans must be created a maximum of 12 weeks from assessment even in the most exceptional circumstances.

To read all Lee's points, and for links to the draft Code and other key documents, follow this link. You can also find there a link to Hafal's own draft response to the consultation - we are trying something new by showing our work in progress and you are welcome to contribute.

Lee's position already has the support of the Mental Health Foundation and MDF the Bipolar Organisation as well as Hafal so we are confident that this campaign has legs and we can achieve vital improvements to the Code.

Big Friendly Village

Another active weekend in the teeth of wet weather, the highlight being a walk on the coast path near Llanelli. The tide is in and occasional sunlight breaks through to create a silvery shimmer which needless to say my photos fail to capture.

The centre of Llanelli is mainly covered in scaffolding as an EU-funded facelift gets underway. I'll reserve judgement until I see the result. I have wondered whether the vast expense of renovating Llanelly House, former home of local crachach the Vaughans and latterly Stepneys, is worthwhile - the building was abandoned as a town house for the gentry in about 1800 and used for business and suchlike since - but the die is cast and we should find out next year.

This unique Welsh community, where the same industrial and non-conformist character which once made it modern and progressive now makes it appear very old-fashioned, does not conform to the characterless and impersonal uniformity of modern urban environments (well, outside the central pedestrian shopping area anyway) either in appearance or, more importantly, in its social atmosphere which remains like that of a big friendly village.

Meanwhile the Coast Path Visitor Centre stands out improbably as a bold bit of modernism...

Inexplicable

Swansea City Premiership celebs Gerhard Tremell and Vangellis Moras visited Hafal’s Ammanford Resource Centre this week and had an in-depth discussion with service users which touched on the parallels between recovering from a serious physical injury and a serious mental illness .

The event was a great success: Huw Lake (Player Liaison Officer), players and service users also discussed issues including social isolation, positive mental attitudes in competitive sport and recovery from serious mental illness.

One other topic was the stress of working in a competitive environment, something a professional footballer isn't really going to be able to avoid but it will get a lot worse later in the season as the titanic struggle to escape demotion comes to a head. Jack Army stalwart and Hafal Deputy Chief Exec Alun Thomas thinks they stand some chance as their home goal remains watertight...so far.

I'm strictly neutral as there are a number of Cardiff supporters among us - both clients and staff - who inexplicably failed to join in the celebrations when their neighbours down west went up.

Keith Wins Oscar

Keith Jones (centre) with fellow award winners and BBC Wales Today presenter Lucy Owen (far left) and Health and Social Services Minister Lesley Griffiths AM (second left)

Congratulations to Hafal's Keith Jones who has won a Gold award at the prestigious Wales Care Awards 2011 - the "Oscars" of the caring world.

Keith, a widely-respected Practice Leader based in Bridgend, was presented with the "Promoting Fulfilled Lives" Award at a ceremony attended by Health and Social Services Minister Lesley Griffiths AM at City Hall, Cardiff on October 21st.

Keith was nominated for the award by a service user who has since moved from Hafal's halfway house in Bridgend to his own accommodation and said: "Everybody who has worked here and has lived here has enjoyed his company. He is fun to be with and is friendly and understanding." And Keith's colleagues, who are delighted at this richly-deserved recognition, all echo that view.

Keith, a native of Pyle, Bridgend, worked as a taxi driver for six years but an interest in the caring profession saw him switch to work with adults with learning disabilities and latterly with people recovering from serious mental illness. Keith says he derives great satisfaction from seeing service users achieve their goals.

Cool threads too, Keith...

Blitz

Trying to catch up with a minimum level of fitness I do a gruelling gym yesterday and a couple of long walks today. The autumn has set in properly - the devil has p*ssed on the blackberries (as country folk charmingly put it) so Mrs Blog has moved on to collecting chestnuts, her only serious competitors being the local Chinese community (well, one family actually) so there is plenty to go around.

Of course there's nothing better than just roasting them on the fire but if you want to keep them pop them in boiling water for five minutes and the skin can then be cut away easily and you can freeze the edible insides - quite a valuable crop. Ours is being saved to stuff the Christmas bird and some other delicacies.

This is also the time for pumpkins which are fun for Halloween but should also be used to make this fabulously creamy and yet not at all unhealthy soup...

Toss 2 lbs pumpkin flesh (cut into chunks)and 6 whole unpeeled garlic cloves in some olive oil then roast at 400F for half an hour. Meanwhile finely chop two onions and 2 celery sticks and fry in the bottom of a large saucepan in some more oil. Add 2 1/2 pints of good chicken stock (best you can manage - the quality will depend on this), 2 oz rice, plus the pumpkin and garlic (remove the skin first); simmer for 15 minutes then blitz in a processor (or whatever you use) until creamy. Season well and reheat to serve with some parsley on top.

You can add a bit of cream when you serve to fancy it up but there's really no need. If you don't like garlic or you are vegetarian best find another recipe - you'll need some other flavours and there are plenty of variants on-line although they won't be as good as this one.



Postscript:

So the French put up a good fight but went down to the favourites. What might have been if we had made the final as justice demanded! Ho hum.

Allez Les Blancs?

So Wales came fourth let down again by their kicking. Attention turns to the final and I'm coming out for France which I know is not the done thing around here. But they have sportingly agreed to wear white whereas they could have made the All Blacks change. Julien Bonnaire says they should have stuck to their rights especially since the NZ media is full of stuff about Gallic naughtiness like eye-gouging. As if his consummately sporting nation would ever stoop so low.

In the end you've got to support this mutinous, shabby and chaotic outfit because it would be so remarkable for them to whip their confident hosts. But I'm not holding my breath.

And Another Thing

Since my last post Hafal's policy expert Peter Martin (pictured above with Darren Millar AM last week) has read the draft Code of Practice more carefully than me and points to the absence of clear timescales for the critical periods (i) between referral and assessment and (ii) between assessment and completion of a Care and Treatment Plan.

Of course we all recognise that there needs to be some flexibility for different circumstances but words like "timely" and "appropriate" aren't good enough: we need a specified range of times including a maximum time only to be exceeded in the most exceptional circumstances.

A particular concern, especially of some carers for obvious reasons, is the problem of creating Care Plans for people who refuse to engage with services - often because they do not accept that they have an illness. These patients can be floridly psychotic and very vulnerable but Hafal staff have lost count of the number of times we have been told that "he/she obviously can't have a care plan because they won't cooperate".

This is entirely wrong. It is difficult to develop a plan in these circumstances but much can be put in place through engaging with carers and others in touch with the patient including their GP. At the very least the Plan needs to include contact with the family to help them support the patient and scheduled checks on the patient's health and safety and attempts to encourage the patient to engage; and some imaginative ways of getting help to patients should be considered, for example through oblique offers of help concerning physical health, housing, etc which the patient may accept (and of course holistic care planning particularly supports this approach).

The Code does address this issue but it also needs to give specific guidance on timescales in relation to these patients, in particular prescribing the necessity to develop a Plan more urgently for them. Otherwise, believe me, development of Care Plans will be delayed on the excuse that the patient would not cooperate.

This is a delicate area but there is no room for political correctness here. It is folly to delay formal care planning because you are waiting for the patient to "come around to it" - the Plan must be created quickly even if the patient isn't cooperating and it can subsequently be reviewed and improved cooperatively just as soon as the patient chooses to engage - which the Code does point out.

Talk of the Devil

As fast as I pressed the button to publish yesterday's blog we received the draft Code of Practice that I was talking about (follow this link). A quick read suggests that the Government has done a good job on most of this, including welcome detail on the 8 "life areas" and clarity about these being systematically considered in assessments of need. Two bits in particular need improvement I think...

(1) The guidance as drafted on completing a client's Care and Treatment Plan would lead some practitioners to believe that in many cases it would be sufficient to address just two or three of the "life areas" in the Plan. In fact clients need a plan for all the life areas (except, in some cases, clients' parenting or caring responsibilities). That is not to say that mental health services have to take action in all the areas - in many cases other agencies will be involved or indeed the clients may address areas of their Plan by themselves.

One example: if a client is comfortable that they can manage their own housing needs that does not mean the "Accommodation" life area should be left out of the Plan - because the client definitely needs a plan for where they are going to live in the coming months! Rather there should be a simple statement such as "x lives in a Housing Association flat and is confident that he/she can manage rent and services payments, general maintenance of the flat, and relationships with their landlord without support but will contact the Care Coordinator if problems arise". Job done.

A statement of this sort ensures that the "life area" is covered, recognises the responsibility of the client (which is appropriate and in itself therapeutic), and incidentally covers the practitioner very effectively if problems should arise.

By contrast if there is no mention of accommodation in the Plan it will be unclear whether this means (i) there is in fact no action required by mental health services or (ii) another agency's help is needed or (iii) indeed the client can manage for them self or (iv) the matter has just been overlooked or gone unrecorded. This is deeply unsatisfactory and unsafe considering a few words could have transparently cleared the matter up for everybody's benefit.

(2) The advice on the treatments for mental illness "life area" does not specify that both medical and other treatments (including psychological treatments) should be covered in the Plan. Otherwise, frankly, the common practice of not even considering non-medical treatments will persist for many or most clients.

If indeed either medical or non-medical treatments are not appropriate it would be good to read in the Plan words such as "It is agreed that psychological therapies are not appropriate at present". I know it can be argued that this will have been covered at the assessment stage but in practice it is vital to have this clarified in black and white in the ongoing Plan, not least so that at review the matter will be reconsidered.

Hafal's view originally was that there should be quite separate consideration of the two sorts of treatment in Plans rather than dealing with them together. Apparently the amalgamation came as a result of well-meaning people not wanting to dignify medical treatment too much as a distinct area. Understandable perhaps but in practice we risk losing due cosideration of non-medical treatments unless this matter is very clearly addressed in the Code.



I hope the Government, which should take great credit for painstakingly bringing forward this radical and ground-breaking legislation, will go the extra mile and improve the Code in order to prescribe without ambiguity a truly holistic approach to mental health which embraces the responsibilities of patients as well as of professionals and modern talking therapies as well as medicine.

Anyway, enough from me. I'm delighted to report that Lee McCabe, veteran campaigner for the Measure (indeed he's actually the person who instigated it as acknowledged by Jonathan Morgan, the former AM who got the ball rolling with the LCO) has agreed to dust off his armour like Cincinnatus and take the lead in a public campaign on the Code - watch this space...

Here's Lee chatting to the Minister last week: apparently she suggested he puts his role in initiating the Measure in his CV - good advice!

Another Day Another Dollar

Well, I'm back from my holiday and attuning myself again to the world of work. It feels a long time until next summer as I'm swimming outside in the dark each morning (in the heated pool at my gym I hasten to say) until the hour change at the end of the month - but there's no escape as that will herald travelling home in the dark for the next few months.

It's not really natural to spend all the daylight hours indoors but (on the bright side) working outside isn't much fun in the winter and I suppose it's better than working down a mine where, if you had a day shift, you might not even see daylight for days at a time.

This seems like a good moment for taking stock of what we've achieved this summer. The "Taking the Wheel" campaign has really caught everybody's imagination. In particular our messages about putting patients at the heart of services - for real I mean, not just as a stale old mantra - have really landed and I have some optimism that the Government's new Mental Health Strategy will be built on the individual Care and Treatment Plans at the core of the Measure which Hafal Members instigated several years ago. Those Plans will need to focus systematically on the eight holistic "life areas" which Hafal pioneered and which are included within the law itself.

Of course there is more to do. the Regulations for the Measure will be published shortly as will the draft Code of Practice - we need to ensure that the Code is at least as clear and prescriptive as the Government's Interim Guidance on CPA currently in force - so make sure you get to one of the consultation events (details available from Hafal if you haven't got them).

See our report from "Taking the Wheel" here.

An Echo of 1980

Oh dear, oh dear, oh dear what a travesty! And am I alone in detecting an echo of 1980 in today's game? Back then England beat Wales 9 - 8 against the tide of history following the controversial sending off early in the game of my hero and fellow-flanker Paul Ringer, one of the seriously hard men of Welsh rugby - that's putting it politely and I don't suppose Sam Warburton would take too kindly to being compared with this legendary tough.

Like today on that occasion Wales won on tries (2 - 0 in fact - only four for a try in those days) in a game that was dubbed the "Battle of Twickenham" because of the brutal aggression shown by the Welsh from the start. Indeed the sending off was a case of making an example following a lot of fierce play, something which today's ref could not point to.

I was at university (in England) at the time and watched the game at a friend's house with a crowd of England supporters who became prissy and self-righteous about the uncompromising Welsh tactics and I took a lot of stick naturally when England kicked their winning penalty in the closing seconds.

I've still got my "Paul Ringer is innocent" T-shirt somewhere.

Savages

I lived in Haverfordwest for a few months many years ago but until today I had never visited St Mary’s Church. It’s not much to look at having lost its steeple 200 years ago and it’s boxed in by 18C development - though that is not so objectionable compared with the criminal damage committed by 20C planners on the lower end of the town (it was here that I first observed the phenomenon of local government colluding with greedy local businesses to suppress the flexible, transitory and seasonal local economy which market towns had previously offered, not least through low-rent market stalls).

Inside the church looks a mess too, littered with memorials of the Philipps family, the local big-wigs from Picton Castle. But if you squint and abandon close focus you can see a nice 13C church combining solid local craftsmanship with some French frills, notably the finely carved arches in the nave. The roof is Tudor – spot the giveaway roses.

Dominant minorities often mock the majority which surrounds them out of nervousness of dissent and rebellion. The English-Flemish colony here was no exception and used the opportunity of building the church to take a pop at the savages eyeing them
resentfully from north of the Landsker. There are amusing satirical carvings of their neighbours in the form of a monkey playing the Welsh harp, a pig playing a Welsh fiddle, and a carousing Welsh hooligan brandishing a very modern-looking pint tankard.

I should also mention the memorial to Sir John Pryce who kept the embalmed bodies of his first two wives in his bed, unable to sleep without their comforting presence. His third wife most unreasonably put her foot down and made him shift them out.