Spooks

The Five Nations meeting this week (Ireland counts as two for this purpose but nobody is arguing about that)


I've been up in Surrey and London much of this week so just catching up with the Blog...

Once a year five sister charities fighting the corner for people with a serious mental illness and their families meet to compare notes. This year it's the turn of our English colleagues in Rethink Mental Illness to host the meeting.

Among many topics it is interesting to learn that patient groups in England are not opposed to the principles behind the UK Government's Health Bill (actually it's just become an Act) by contrast with the "producer interest" of professional bodies like the BMA, although everybody seems to agree that the thing has become a complete dog's breakfast. The Welsh Government will have to find a way in due course to meet the expectations of modern consumers of health and social care even if, for now, they can sit back and relish the discomfort of the Coalition down the road.

Rethink is now located right next to the MI6 building by Vauxhall Bridge and I take a good look from the 15th floor down onto the spooks' modernist residence which looks like a 1930s radio but am unable to report any sinister goings-on. It occurs to me that it might be a mistake to poke a broom handle out of the window.



Meanwhile back in Wales and with other partners we have announced more details of our plans to climb Pen y Fan in May. Patients and carers are to scale South Wales’ highest peak in the Brecon Beacons to launch our "Movin’ On Up" campaign.

The mountain – which is the highest in any part of southern Britain standing at 886 metres (2,907 ft) above sea-level – will be the first big event of "Movin’" which aims to take service users’ and carers’ campaign for excellent mental health services in Wales to the next level.

Lee McCabe, a former service user who now works as a Recovery Practitioner at Hafal, explained: "The climb is symbolic: we want to demonstrate how service users and carers in Wales can lead the way forward, take services to a new level and achieve new heights in their empowerment by maximising the opportunities provided by the Mental Health Measure, the Carers Measure and the Welsh Government’s new Mental Health Strategy."

The Pen y Fan climb kicks off a summer-long itinerary of events including:

• 22 weekly county events covering the whole of Wales

• a Seminar on May 17th in Builth Wells in which service users and carers will develop their continuing dialogue with senior policy makers and providers of mental health services

• an interactive stand at the Royal Welsh Show in July

The campaign will culminate in a climb of Wales’ highest peak – Snowdon – on September 27th and there will be a follow-up display at the National Assembly on World Mental Health Day in October.

Our mountain climb coordinator Emma Billings tells me: "We’ve already had a huge amount of interest not only from service users and carers wanting to take part in the climbs, but also from mental health professionals from all sectors who want to show their support.

"We’ll also be publishing details of the Snowdon climb in due course. Those who are interested in taking part can contact me and I’ll make sure they receive the information."

Find all the details on this link.

Pan Bagnat

Yesterday I'm out swimming early morning, then cycling around Swansea Bay, followed by lunch alfresco in Wind Street (swarming with police in anticipation of the Everton clash). You've got to make use of the brilliant weather while it lasts.

Today we head to Laugharne with a picnic of pan bagnat (see below). We walk around the headland and back over Sir John's Hill before our lunch then I wander round the town. This takes me back nearly 30 years both to courting Mrs B (prawn sandwiches and Anjou Rosé on the grass under the castle wall seemed to do the trick) and selling the last ever edition of the Carmarthenshire Historian (Volume XX) in bulk wholesale to the Laugharne bookshop (still there).

This enterprise taught me a valuable lesson in commerce. I just couldn't shift the wretched thing until I had the wheeze of adding 50% to the cover price and giving the booksellers a 33% margin in place of the measly 15% traditionally offered by not-for-profit charitable publishers.

Instantly booksellers all over the county, who had previously taken one or two out of politeness, took all the stock and sold it hard on prominent display - I especially remember the buyer in W H Smith in Carmarthen gleefully taking all I could give her. More profit for them and actually a little more for the history society. Of course the people who had bought previous editions had to pay up to keep their series up to date and we got a lot of casual buyers too. I see that it's still available on Amazon but only second-hand I'm pleased to say - because I sold the whole lot back in 1985.

The lesson of course is that sometimes it's not price which drives sales.



Recipe corner

I had a lot of feed-back on the Jumping Soup - several people told me they had made it successfully. So in order to compete with Mrs Blog here's my recipe which I used this morning to prepare our picnic.

Pan Bagnat ("wet bread") is a quintessentially Provençal, more specifically Niçois dish made of raw ingredients. The name looks odd because it's from the region where Occitan is spoken. You can vary or simplify the ingredients so long as you use the oil and tomatoes (so there are veggie and indeed vegan possibilities here) but please don't use cheese and certainly not mayonnaise - you might just as well buy one of those disgusting supermarket sandwiches smothered in the stuff. Needless to say there are violent debates in France about the "official" recipe and I could well be sent to Devil's Island for mine but I think it's pretty authentic...

Mix the following gently in a bowl: medium tin of tuna (around 100 grams) (drained), three big, juicy tomatoes roughly chopped, 8 black olives pitted and chopped, two hard boiled eggs sliced, clove of garlic finely chopped (or use a crusher), a few basil leaves, 4 anchovies chopped, 3 tablespoons of olive oil, one tablespoon red wine vinegar, a grind or two of black pepper, and a little salt - but watch it, there's a lot of salt there already in the anchovies - you can check by taste once stirred.

Split a medium loaf, French stick, or four good size rolls, spoon in the mixture, wrap in cling film and press for at least two hours in a cool place under gentle pressure (e.g. place a tray on the bread and put three or four bags of sugar or flour on top) turning once if you remember. Eat same day and, if not immediately going out for your picnic, then refrigerate but get it out 2 hours before eating.

The idea is to end up with a quite moist, firm, savoury cake - maybe a little crustiness left in the bread but no problem if not. The benchmark for texture (but not taste) would be a two-day old, cling-wrapped British Rail cheese'n'tomato sandwich circa 1978. If you use a loaf you can slice carefully quite like a cake - take a sharp knife with you. You can also ponce it up by layering the ingredients separately in the bread but I don't believe that your average busy Niçoise femme au foyer would have bothered, do you?

Trust me there is nothing better for a picnic in the sunshine except possibly stromboli. I'll do that next time the weather is good.


Red arrow on OS map shows view of picture above...

Stand-offish

Hafal's Facebook has updated to a new format and we are debating its merits. The pictures are bigger which is nice but the timeline feature is a bit odd - but ho hum we'll get used to it.

Even more than last year we'll be featuring every turn of our Movin' On Up summer campaign on Facebook (as well as the website of course which seems to be your overwhelmingly favourite medium still) so take a look here - and click to "like" us!

I set up my own Facebook page a year ago but clicked all the privacy buttons so that nobody can go near me - and indeed they haven't as I have no "friends" at all. This may sound very sad but in truth I haven't accepted any in spite of an avalanche of "requests to be my friend".

If you don't know about Facebook you might draw the conclusion that I must be an extremely popular chap and should be less stand-offish and accept people's proffered hand of friendship. But those of you in the know will recognise the strange phenomenon of people randomly firing off these requests to anybody just because they once had an email from you or went to the same school, etc.

On the whole I think that, used sensibly, Facebook is a very good thing and in particular a good way for people who are lonely, including many people with a mental illness and their families, to sustain and build contacts.

My own reluctance to join up properly is based on a possibly irrational fear of introducing people from different compartments of my life to each other. Perhaps I am worried that if they compared notes they would find me out?

And don't forget the reality check. I recollect one of my nephews saying gleefully about their Facebook presence "Look, Granny, I've got 500 friends!" to which my Mum wisely replied without lowering her newspaper "No you haven't". Most people, including me, only have three or four real friends and it's unrealistic and not necessary to have many more. Not having those three or four is what loneliness is really about but the wider acquaintance which Facebook offers can help and, once in a while, may even lead to the occasional real friendship.

My three or four friends aren't on Facebook or, if they are, they haven't told me about it. Now that would be sad.

Lost Tribe

Breaking news today that the two journalists held in Tripoli had been detained on suspicion of being Israeli spies because their captors mistook Welsh for Hebrew - see the story here.

Before you mock the Libyan militia for an egregious mistake bear in mind that they may know something that we don't. There is a longstanding tradition that the Welsh are one of the Lost Tribes of Israel who were expelled by the Assyrians in about 760 BC and disappeared from history.

But did they? They must have gone somewhere and may have wandered west and become ancient Britons (as the Welsh were known before the Saxons arrived). The Lost Tribe most associated with the Welsh is the tribe of Dan who seem to have been excommunicated by the other tribes for "pagan practices" - whatever that may mean but it sounds quite Druidical.

Dragons (or things very like them) crop up a fair bit in the Old Testament - and uniquely in the world there is a dragon over the door of the synagogue in Thomastown, Merthyr Tydfil, the oldest in Wales and still in use when I lived nearby briefly in the 1980s.

And, now I come to think of it, I had a great uncle Dan who farmed near Tregaron.

The evidence mounts up.

Movin' On Up - It's Official!

Take a look at the details of our new campaign here (including a brilliant animation of the microbus passing through a stereotypical Welsh landscape) and decide which of the events and challenges you would like to participate in - full list here.

This is surely going to be our biggest and best campaign to date - and definitely the most active and healthy. I'm looking forward to limbering up by scaling Pen y Fan in May and then, hopefully fully fit after an active summer, shimmying up Snowdon in late September.

The Snowdon climb is quite a bit more challenging. It's the higher mountain of course but also because the route we are using on Pen y Fan starts half way up near Storey Arms on the A470 - should be straightforward for most people with basic fitness and the proper kit (which we will be giving clear advice about).

Just to prove I can do it here's me atop Pen y Fan in September 2010...



...hmm, looking quite a lot fitter than I do now, on reflection, but I did climb it then from the abandoned army camp near Brecon which is a lot further and a little treacherous as you have to scurry up the rocky north face - no such problems on the route we have chosen for you, however.

Oh, and this all has a serious purpose of course. As part of the “Movin’ On Up” campaign service users and their families will:

• Engage in the development and implementation of the new Mental Health Strategy ensuring that it is recovery-focused, empowers service users and their families, and supports the Mental Health Measure by prescribing the services which individual Care and Treatment Plans demand.

• Take full advantage of the Mental Health Measure which promotes holistic care and treatment planning. The campaign will see service users taking the lead in negotiating robust Care and Treatment Plans which address all areas of life. Service users and their carers will challenge mental health and other services to deliver on the new law by acting on the Care and Treatment Plans in collaboration with their clients. They will also challenge the Welsh Government, NHS and local authorities to ensure that resources for mental health and other services are focused on meeting needs identified in the Care and Treatment Plans.

• Ensure that the families and carers of people with a serious mental illness are able to exercise their rights under the new Carers’ Measure and Mental Health Measure so that they can support the people they care for on their path to recovery – and achieve a better life themselves.

• Promote the take-up of other opportunities provided by the new Mental Health Measure for improved primary care services (including mental health assessments, short-term interventions and onward referral to secondary services), for an expanded scheme of independent mental health advocacy for all in-patients, and for improved and faster re-access rights for those who have been discharged from secondary services.

Join us this summer and have fun getting fit - and changing the world!


Postcript: I've just found this pic of me on the way down from Snowdon in 2009. You will have to take my word for it that I actually made it to the top (and without using the train)...

Movin' On Up

I'm using my privileged access to give you a sneak preview of our summer campaign which we will announce formally next week. Like last year we are working with our friends in the Mental Health Foundation and Bipolar UK to support people with a mental illness and their families to fight their corner - but things have changed (not least as a result of patient pressure, for example on the Mental Health Measure and its Regulations) so the focus of their campaign for excellent mental health services in Wales will move on up to the next level.

The big new challenges this year include...

• Getting a good deal for people with a serious mental illness from the new Mental Health Strategy.

• Ensuring that the Mental Health Measure is implemented effectively, in particular making sure that patients get excellent Care and Treatment Plans and that these are acted on.

• Making sure that carers of people with a mental illness gain real improvements from implementation of the Carers Measure.

There will be activity every week right through from early May to the end of September and beyond so watch out for the full details next week - I'll provide links on this blog if you don't catch them first on the websites (see links to the right).

And dust off and apply some dubbin to your walking boots - there will be mountains to climb and not just metaphorically!

Jumping Soup

In my blog post earlier today I asserted confidently that mental health services haven't any useful advice to offer about our general happiness and contentment but that doesn't mean that good advice on that very subject doesn't exist. It's just that you won't get it from mental health services - no, not even Hafal but at least we don't poke our noses into the matter. By contrast I can point to one useful source...

Mrs Blog prepares huge vats of soup for the freezer which is then dispensed in 3/4 pint units for me to heat up in work for lunch. A couple of years ago she undertook an informal customer satisfaction survey by eliciting my comments. The best report was for the lentil and chorizo soup which I described as making me "jump for joy" when I find it in my brief-case on those otherwise dismal winter days which challenge the bonhomie of even the sunniest-dispositioned P.A.Y.E. slave. Since then this example of frugal Spanish cuisine has been known in Blog Towers as "Jumping Soup".

Describing this story to Hafal's Tina Arnold (known to many of you as the friendly face of our busy Membership Department) I promised her the recipe but then thought I might as well share it more widely...

Fry a chopped onion and a diced carrot in a tablespoon of olive oil; add two chopped cloves of garlic and stir for a few seconds; add 2 pints of stock, a bouquet garni, and a tin of tomatoes; season then bring to boil and simmer for half an hour; add 4 oz red lentils and 4 - 6 oz chopped chorizo sausage and simmer for another 25 minutes; remove the bouquet, blitz with a Bamix, food processor, or liquidiser, adjust seasoning and serve (or cool and freeze). Serves 4 Spanish peasants or 6 wimps.

Yum. It's the fat in the sausage enhanced by the smokey paprika which makes this soup fly. Like the best cooking it owes its creation to canny peasants on one Peseta a day (standard pay in Spain until about 1960) eking out the basics - in this case lentils - with a tiny bit of something richer. Chorizo sausage can be bought in most supermarkets and it's quite cheap - Mrs B recommends Lidl. It's also a great diet aid as its flavour is so strong and warm that you can use it very sparingly in risotto and other healthy dishes requiring some pizzazz.

There's no real veggie alternative although you could try using smoked paprika instead of the sausage - no doubt nice enough but no self-respecting campesino would pick olives or grapes all day in the arid dust-bowls of Almeria on such slight fare (nor, with less justification, would I do my job to be frank).


Forage alert: wild garlic is good to pick, early because of the warm weather. Details from last year here.

Nifty

click on the Chart for a more legible image


As the Welsh Government drafts its new Mental Health Strategy it could do worse than focus on the win-win potential of recovery as the way forward for people with a mental illness which not only delivers what they and their families want but also the most cost-effective results.

To illustrate this take a look at Hafal's nifty Cost-Recovery Chart above which illustrates that even modest progress by patients can save substantial sums, thereby releasing funding for new patients and potentially creating a virtuous circle of success with improved recovery leading to yet further improved services.

It's also worth noting that concentrating resources on recovery for people with the highest needs is a vastly more cost-effective way to deploy resources compared with prevention though that of course has a place in the Strategy.

The problem with preventive approaches is that to date nobody has found reliable predictors, still less prophylactic measures which could prevent most serious mental illnesses - a quite different story to (say) heart disease where there is plenty which can usefully be done.

There is certainly an argument for engaging the wider population in basic understanding of mental illness so that they can respond intelligently and without discrimination to people who are ill and when they or their loved ones become unwell. But there is no useful function for mental health services or the government in telling well people how to stay happy and content - on the contrary the language of mental health services is particularly disempowering and unhelpful to people trying to get on with their lives (see this post).

Of course I mean prevention in the pure sense: early intervention when symptoms first manifest themselves can be very effective (and cost-effective) and should be a core element in the Strategy.

So there is no dilemma on this. The Minister of Health Leslie Griffiths has correctly said that the priority for health and social services should be those with the highest needs; in the case of mental health the economics say likewise.

Hanky-Panky

Sigmund Freud by Hafal Blaenau Gwent


An excellent meeting yesterday of all Hafal staff and Trustees in which we worked out how to support patients and carers to get the best out of the new Mental Health Strategy (due to be published in draft late spring) and the Mental Health Measure (implementation of the important bit - Care and Treatment Plans under Part 2 - from 6 June). It is good to see staff so buoyant and committed in spite of the economic situation - and we will make a lot of noise this summer to promote the interests of people with a serious mental illness and their families!

Meanwhile I receive an interesting portrait of Sigmund Freud from service users in our art group in Blaenau Gwent which Hafal's Malcolm O'Callaghan has kindly forwarded.

This reminds me that I missed the new film about Freud and Jung - A Dangerous Method - which came out a couple of weeks ago. I will catch up with it in due course and tell you what I think but I suspect the audience may be mixed, one group there to witness the famous stand-off between the founder of psychoanalysis and his disloyal acolyte, the other there to gawp at Keira Knightley (Sabina Spielrein) being spanked by Michael Fassbinder (Carl Jung), a short scene which has been widely publicised by the film's promoters (including many, many interviews with Ms Knightley who says it was embarrassing to perform and to talk about...). The latter group may be the larger, I'm afraid, even though there is no evidence that this event - or indeed any hanky-panky - ever took place.

It has always been fashionable to sneer at Freud and his disciples, hinting that the importance of sex in their theories must mean they were all at it themselves in inappropriate ways - and in fact there is evidence of behaviour in that circle which would fall a long way short of modern standards for professional therapists. It has also become fashionable to say that anyway Freud "got it all wrong" about us - and again it is compelling that there are flaws in his theories (and more in Jung's if you ask me).

But none of this innuendo and genuine doubt can get away from the fact that he entered for the first time into the workings of our minds and uncovered great truths about that previously unexplored territory. The jokey evasion of serious discussion about Freud's theories speaks volumes about our suppressed anxieties and taboos in acknowledging our own true natures.


Jung, Spielrein, and Freud

The Hump

Forgot to post this Sunday so here it is late...

Another active weekend in this amazing sunshine, although while hiking along the banks of the Towy at 5pm I was caught by an intense barrage of hail the size - and temperature - of frozen peas: my face is still stinging.

Out walking I contemplate the important news that veteran crooner Engelbert Humperdinck has been chosen to represent the UK in the Eurovision Song Contest. Congratulations to whoever made this inspired choice which is so right on so many levels. Either the choice is satirical - putting up an improbable and (ahem) mature artiste in order to show up the relentless naffness of this wretched event - or it is serious in which case it scores on two equal opportunities points - he's getting on in years (even older than Croatian rapper Ladislav Demeterffy who competed in 2008 and has since died of old age) and his mum is Indian.

He will have to sing a new number which is a shame as Release Me is surely an all-time hit which would wipe the floor with the Eurotrash competition. Nevertheless apparently the odds have been slashed for a British victory - like Kent's own caterwauler Kate Bush the Hump is at least as popular in Europe as in Britain where we shamefully find it hard to take these acts seriously.

Quiz

I was looking on-line at the activities of our friends in the United States the National Alliance on Mental Illness (NAMI) and came across their quiz on schizophrenia: try it yourself via this link. I got one question wrong (although I think it was ambiguous!).

We should take more notice of what is happening in the US. Their health care systems may look alien to us but there are plenty of lessons for us nevertheless. NAMI, with whom Hafal has had very productive contact, is an admirable mass-membership organisation with a record of informed and assertive campaigning together with a refreshing, no-nonsense understanding of the priority needs of people with a serious mental illness.

"Denbigh Mental"

Tŷ Llidiard, the new children's mental health unit which opened this week in Bridgend

Important news here about mental health services for children as the Welsh Government publishes its first annual report on "Breaking the Barriers - Meeting the Challenges" which is the year-old Action Plan resulting from "Everybody's Business" which set out the Government's strategy for Child and Adolescent Mental Health Services in Wales. Lots of paper then but is it making a difference?

You can't quarrel with the investment in the new facility in Bridgend (picture above) of which the Minister of Health Lesley Griffiths AM said "I'm absolutely blown away; the attention to detail that's gone into this building is unbelievable.

"When children and young people experience mental health problems it is important the right services are there ready to provide support to them and their families. Here at Tŷ Llidiard young patients will receive treatment in a comfortable, friendly and safe environment which is wholly appropriate to their needs while they are at their most vulnerable."

The Minister also gave an interesting insight into her own observation of changes in mental health services over the years: "I started my working life about thirty years ago in the North Wales Hospital, Denbigh, a massive Victorian institution. To see changes like this that have taken place in mental health services in that time is amazing. This is fantastic facility for children and staff."


The former North Wales Hospital (aka "Denbigh Mental")

Well, by any standards the old hospital is a better piece of architecture but let's not grudge the Minister the right to contrast the buildings. More seriously the story has not of course been unambiguously one of continuing improvement as across Wales many patients with the highest needs have been ill-served since hospitals have been run down and closed because there was neither the resources nor the imagination deployed to support them effectively in the community. But let's try to look forward.

On the annual report Hafal's John Gilheany comments "While progress has been made the report recognises areas of concern such as the fact that while more than 50% of children with severe learning disabilities have significant mental health problems only a small percentage receive services; and also the 'dramatic' reduction of Social Worker posts in specialist CAMHS. The report also acknowledges the problems to be faced in delivering services in the current economic climate."

To get a real, human understanding of what life can be like for young people experiencing mental illness in Wales today take a look at Sarah Stanyon's courageous and telling account of her experience in the latest edition of Mental Health Wales.

Sarah describes poignantly how at one stage "I basically hid from the world for the next three years. I was unable to find employment because of a lack of confidence and I felt lonely because I had alienated myself from most of my friends. In 2009 I moved to a residential program in Sheffield but returned to Swansea a year later in a worse state than when I left: I was hearing voices, severely anxious and suicidal. The help I received from the NHS was minimal and I had to wait six months to see a psychiatrist."

See Sarah's whole story, including some better experiences of mental health services, here. In spite of the inconsistent support which she received Sarah does advise people to seek help: "If I could say one thing about mental illness it would be this: if you think you have a mental illness do not be afraid to speak out and find help. There is a lot of support out there for you and people are, for the most part, understanding and want to help you."