BAUBLES, BANGLES and BRIGHT SHINY THINGS

First of all, a huge welcome to Manchester to all of you attending the Conservative Party Conference. Whilst I'm sure the weeks agenda is a full and exciting one, the wonderful world of Arts and Health offers you the most splendid welcome if you'd like to have a conversation about 21st Century well-being and health. Arguably the crucible of this growing global movement that sees culture and the arts playing a critical role in how we put patients at the heart of care. (lets remember the word q u a l i t y) But beyond the expanding and contacting landscape of the NHS, wellbeing is best promoted in all those schools, shopping centres, prisons and streets - the places that we all live our day-to-day realities. So, if you're a member of parliament, a minister of state, a civil servant or an interested other and you genuinely care about health and wellbeing, get in touch and find out more about our offer to you.

I got an intriguing email from the designers, Conway and Young. To mark the 65th anniversary of the NHS; a healthcare system that is free for all at the point of delivery, based on clinical need and not ability to pay - they were speculating what a future NHS might look like. With a chilling provocation, they asked me to imagine, THE YEAR IS 2078 AND THE NHS NO LONGER EXISTS and I was invited to speculate along with 64 other people, what this landscape might look like. I’m not quite sure that I’ve produced what they wanted, but I share with you some dystopian ramblings. I’d like to think of this as the bastard progeny of Jonathan Swift’s economist in A Modest Proposal married to a Riddley Walker aesthetic, with the uplifting people-friendly, feel-good-factor of Soylent Green. Whilst I was able to play with this, I am in debt to Sarah Lawton for her interpretation, her eye for a grand thing and uncanny ability with an A0 printer! A couple of variants will be posted on the blog over the next couple of weeks. I can’t wait to see what Conway and Young entice from other contributors and how they turn all this material around and of course, I’ll link it on the blog when it comes to fruition.

The above image is one of two on this posting by the sublime poet, Robert Montgomery.

Last week, a few people got in touch about the Hidden Mothers images, so this week I can’t resist a friendly little jab at our friends in haute couture who wrap their fetish-based misogyny in grander terms, but don’t half like to hide/olize women too! Here is Jean Shrimpton, courtesy of Avedon. Much as though I'm tempted to post photographs of Femen activists taking to the catwalks - I can't have that one misconstrued! So, just a respectful acknowledgement and a nervous smile.

Just, What do we know about the role of the arts in the delivery of social care?

A new report into the role of the arts within the delivery of social care has been published this week, the culmination of a study commissioned by Creative & Cultural Skills, Skills for Care, and Skills for Care and Development. Catherine Large, Joint CEO, Creative & Cultural Skills, highlighted the need for greater dialogue between the creative and social care sectors: “The care sector needs to recruit an estimated 90,000 qualified workers per year to replace those leaving the sector through retirement and career progression. At the same time, there are thousands of young people graduating from creative arts courses every year who struggle to find employment – surely there is a way we can work together to create meaningful roles for creative practitioners whilst also benefiting those in care settings?”

Download the full report by clicking on the lovely green and unfurling frond.

2014 Hippocrates Prize
With categories for the NHS, young people and an open call, this is a must for poets concerned with health and wellbeing. With a 1st prize for the winning poem in each category of £5,000, the Hippocrates Prize is one of the highest value poetry awards in the world for a single poem. In its first 4 years, the Hippocrates Prize has attracted over 5000 entries from 55 countries, from the Americas to Fiji and Finland to Australasia. Click on the second Montgomery piece below to find out more.

Clore Poetry & Literature Awards

The Clore Duffield Foundation has announced that the sixth funding round under its £1 million programme to fund poetry and literature initiatives for children and young people across the UK is now open for applications. Through the programme, schools, FE colleges, community groups, libraries and other arts/cultural organisations can apply for grants of between £1,000 and £10,000 to support participatory learning projects and programmes focused on literature, poetry and creative writing for under 19s.

The closing date for applications is the 7th March 2014. Read more at: http://www.cloreduffield.org.uk/page_sub.php?id=331&parent=35

I will be out of the county next week, but I hope that the blog will, at the very least, contain a tasty morsel on the humble Puffer Fish. Here's a clue for the public art aficionados, or those of you with an eye for global inequalities.

Nominet Trust Digital Edge Programme 

The Nominet Trust has announced that the next advisory closing date for its Digital Edge programme is the 27th November 2013. The Digital Edge programme aims to support projects that use new technology to engage young people in new, more meaningful and relevant ways and enable their participation in building a more resilient society.  There is no upper or lower funding limit as the Trust like to encourage applicants to be realistic about what they need to achieve their project objectives. The Advisory Stage 1 date is set to allow enough lead time for successful applicants to have sufficient time to complete their Stage 2 application. There is also a final deadline date for Stage1 applications; any applications received after this date will not be included in the current funding round. The final deadline for applications is the 11th December 2013.  http://www.nominettrust.org.uk/how-to-apply/areas-investment/digital-edge

This little wood engraving is by the minor artist John Farleigh and is called melancholia. I include it simply because sometimes, artists just get it so, so right.   Thanks as ever...C.P.

Unconventional Wisdom: Organic Reasons for Depressive Symptoms

As many readers will know by now, I think we need to be challenging and debating the logic that accepts “mental illness” as a valid concept.  I am concerned that our mainstream acceptance of the idea of “mental illness”, within our health and social care services, our mental health laws and our society, leads us to act in ways that, although well intentioned, cause bad consequences.  Ultimately this may result in more harm than good for people affected by the idea that experiences and actions can be diagnosed as "symptoms" of “mental illness”. 

Last Thursday, in our “Shaping Services Together” Conference, I think that we succeeded in furthering this debate in Powys (watch this space for upcoming blogs that will tell you more about that event.)  With the help of Jacqui Dillon and Jo Mussen the morning started with us being asked to consider the following question:  

“Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?” 

In this vein, I want to continue the theme from my last blog about organic reasons for psychosis by exploring organic reasons for depressive symptoms, again to try and make sure that:

In our drive to suggest that people are asked "what has happened to you" rather than “what is wrong with you”, let's not miss the question “is there anything physically/organically wrong with you?” 

Map of Medicine, which is the NHS system that claims to provide access to comprehensive, evidence-based guidance and clinical decision support, lists the following as typical symptoms of depression:

• an unusually sad mood that does not go away 
• loss of enjoyment and interest in activities that used to be enjoyable 
• tiredness and lack of energy 
• crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation 
• chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains

A diagnosis of depression by a medical professional (in the case of depression, most often made by GPs) will be based on the number of these symptoms that you are experiencing/exhibiting, and whether you have experienced the symptoms for at least two weeks.

What are the known organic causes of these typical depressive symptoms?

Firstly let me try and clarify that by organic causes of depression I mean where the depressive symptoms are the direct result of an organic cause.  I do not include conditions where it is the actual coping with the organic condition, such as  cancer, dementia, heart disease, that results in us experiencing emotional stress and natural feelings of hopelessness, despair, loss of enjoyment and tiredness, feelings that could be diagnosed as “depression”.  Instead I am trying to find out about organic/biological conditions that cause a change in our physiological functioning that lead to the symptoms of depression that I  listed above. 

The Clinical Knowledge Summary from the National Institute for Health and Social Care Excellence (NICE) lists the following as organic reasons for depressive symptoms:

• Carbon monoxide poisoning   
• hyperthyroidism and hypothyroidism – state in which the thyroid gland production of thyroid hormones, thyroxine and triiodothyronine, is abnormal
• Rare side effects of prescription medication, such as: 
• antihypertensives used to treat high blood pressure 
• lipid-soluble beta used to treat a number of conditions including heart disease and high blood pressure 
• central nervous system depressants used to slow down brain activity prescribed for conditions including insomnia, muscle tension, pain, epliespy, anxiety and mood “disorders” 
• Opioid analgesics, generally uised for pain management 
• Isotretinoin primarily used for acne

However,as with my blog on organic reasons for psychosis, other organic reasons for depressive symptoms are to be found elsewhere on NHS sites.  These include:

• Cushing's syndrome, caused by very high levels of a hormone called cortisol 
• Hypercalcemia caused by abnormal levels of serum calcium concentration.  Also a complication of Pagets Disease 
• Hyponatremia where sodium ion concentration in the plasma is lower than normal 
• Diabetes when the pancreas does not produce enough insulin to maintain a normal blood glucose level, or your body is unable to use the insulin that is produced 
• Neurologic disordera such as Epilespy, Stroke, subdural hematoma, multiple sclerosis, brain tumors (especially frontal), Parkinson's disease, Huntington's disease, epilepsy, syphilis, dementias 
• Nutritional disorder such as Vitamin B12 deficiency, pellagra caused by a chronic lack of niacin (vitamin B3) 
• Other disorders such as viral infection and carcinoma

How do these organic/biological causes result in us experiencing depressive symptoms?

In many different ways it seems.  Some of the physical conditions listed above result in an imbalance of the hormones that we need to keep our bodily process working efficiently (e.g. thyroid hormones, insulin, cortisol).  When our hormone production or our ability to effectively use these hormones goes wrong, then a direct result can be symptoms of low mood, lack of enjoyment, tiredness, mood swings and lethargy.

Some of the conditions listed above cause damage to our brains in the areas that are know affect our mood so again the effect of this damage results directly in depressive symptoms. 

When someone experiencing depressive symptoms presents to a health care professional, what investigations will occur to determine whether there is an organic cause?

So back to the NHS Map of Medicine then.  It states that people presenting to health professionals with suspected depression may, “depending on the judgment of the clinical professional of the nature of their presentations”, expect to have medical investigations done to rule out an organic cause for their depressive symptoms.  The investigations are listed on this site but they include biochemistry tests, such as blood glucose, liver function tests, thyroid function tests and hematology tests such as full blood count.

Can depressive symptoms be misdiagnosed as a "mental illness" in this case “depression” when they are actually caused by organic/physical conditions? 

Unfortunately it seems that the answer to this is yes, again as it was with psychotic symptoms.  It is not difficult to find examples of organic problems being misdiagnosed as “depression” from across the academic world, the press and from people’s stories.    So examples where someone is diagnosed with "depression" and treated for this first, rather than the organic reason being found and appropriate treatment for the biological condition being given (e.g. removal of brain tumor, treatment for Hyperthyroidism).  

How often can the psychological symptoms we experience actually be explained by organic/physical/medical reasons? 

There is of course a lot of information about this on the internet but I really am not sure we know the definite answer to this.  It seems that a conservative estimate that about 10% of all psychological symptoms may be due to medical reasons, as this study suggests.   However the results of one study suggest that about 50% of individuals with a “mental illness” diagnosis actually have general medical conditions that are largely undiagnosed that may cause or exacerbate psychiatric symptoms.

So over to you again. Can you help me answer these questions?  Are they questions worth asking?  Tell me what you think ...

• Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?
• In our drive to ensure that people are asked "what has happened to you" rather than “what is wrong with you”, lets not miss the question “is there anything physically/organically wrong with you”.
• What are the known organic causes of typical depressive symptoms and how do these organic causes make us feel “depressed”?
• When someone experiencing depressive symptoms presents to a health care professional, what investigations will occur to determine whether there is an organic cause?
• Can depressive symptoms be misdiagnosed as a "mental illness" in this case “depression” when they are actually caused by organic/physical conditions?
• How often can the psychological symptoms we experience actually be explained by organic/physical/medical reasons?

Hidden Mothers, Artlines, Music, Money and more...

Looking up images of the niquab to enable a succinct contribution to the debate as to whether doctors and nurses should be able to wear the veil at work, I found myself rather distracted not by the usual images, but something I’d never seen or heard of before: HIDDEN MOTHERS. Good grief! In early photography, if the subject for the image was your squirming bundle of joy and poor old mamma was to be kept out of shot, the photographer would drape a suitable swatch of damask over her bonce! So - the resulting historical images are known as Hidden Mother Photographs. As to the ‘debate’ on the niquab, I’d much rather hear what the women involved think, rather than politicians and hacks putting disquiet in our minds where it never was in the first place. The molecular biologist and activist, Sahar Al Faifi at least talks about wearing the niquab, first hand and perhaps sets the scene less sensationally.

And with fleeting thoughts on misogyny in mind, news that Tony Abbott has appointed himself as minister for women's issues in a cabinet of 19, where there is as yet, one female minister, brings no surprises. I wonder if UKIP will offer the ludicrous MEP (‘...you’re all sluts’) ((Oh - and 'everybody laughed, including all the women.' Well that's alright then)) Godfrey Bloom to serve on Abbott’s crack team, I’m sure there’ll be some old post-colonial sabbatical opportunity for him. 

Back to Blighty and some excellent news from my colleague Langley Brown, to whom my biggest thanks.

ARTLINES

Arts for Health and Special Collections at Manchester Metropolitan University have received an award from the Wellcome Trust to commission an archivist and a conservator to assess the extent and condition of archives relating to arts and health, and to make recommendations as to how best to preserve, link, develop and promote these collections.

This award follows an AHRC funded audit by Dr Rebecca Gordon-Nesbitt of archives held by organisations across Greater Manchester, and a UK national consultation by Arts for Health Research Fellow Dr Langley Brown as to the wishes of organisations with regard to any archives held. Those organisations who expressed appreciable interest in the archives project, and whose work is representative of the field, will form the first strand of a long-term project to link such archives worldwide, and to grow ARTLINES as an evolving timeline and family tree connecting culture, health, the arts and wellbeing across time and place, and among domains of knowledge and experience.

The time from today back to the expansion of the arts:health movement in the 70s and 80s represents a career span; this means that those who were involved at the beginning of this journey are approaching or have attained retirement age. Some have died. If we are to gather together the patchwork of histories that have formed the arts:health phenomenon, we must act quickly to ensure that the documentary evidence is preserved, coherently managed, and made accessible to researchers and public, whilst the pioneers are still around to help contextualise the material.

Those represented in this first phase of the archives project are the network of 13 Greater Manchester organisations including Arts for Health and Lime, the Centre for Medical Humanities at the University of Durham, Healing Arts Isle of Wight, and Artlink West Yorkshire. 

Archivist Judith Etherton and conservator Helen Lindsay will be based at Manchester Metropolitan University during November, and their report will inform the next phase of the ARTLINES project. If you’d like to know more about ARTLINES, email langley.brown@mmu.ac.uk 

MUSIC FOR HEALTH

Music for Health has moved from the RNCM to become part of the award winning charity Lime, forming Lime Music for Health which will deliver a comprehensive music programme at Central Manchester University Hospitals. You can read more about this on Music for Health patron, Jules Holland.

With the continued support of the Charitable Funds Committee and a significant investment from Youth Music, the Music for Health team is now looking to recruit three new Apprentice Musicians to join a team of Experts (Ros Hawley, Mark Fisher and Holly Marland) and Mentors (Cecily Smith, Ruth Spargo and Tom Sherman) for the Medical Notes Programme which will run for 2 years at Royal Manchester Children's Hospital. 

A description of the programme, the brief for Apprentices and application details are available on the Blog.

Esmée Fairbain Trust

Esmée Fairbairn aims to improve the quality of life throughout the UK. They do this by funding the charitable activities of organisations that have the ideas and ability to achieve change for the better. The Foundation like to consider work which others may find hard to fund, perhaps because it breaks new ground, appears too risky, requires core funding, or needs a more  unusual form of financial help such as a loan. They also take the initiative where new thinking is required or where we believe there are important unexplored opportunities. Main Funds are within four areas of interest – the arts, education and learning, the environment and enabling disadvantaged people to participate fully in society. They prioritise work that:

· Addresses a significant gap in provision

· Develops or strengthens good practice

· Challenges convention or takes a risk in order to address a difficult issue

· Tests out new ideas or practices

· Takes an enterprising approach to achieving its aims

· Sets out to influence policy or change behaviour more widely.

Application Deadlines: First stage applications can be made at any time, if successful applicants will be advised by the Foundation on how to proceed with the next stage. Full details of the application process can be accessed via the following link: 

http://esmeefairbairn.org.uk/apply-for-funding/guide-to-applying/select-your-fund/main-fund/main-fund-application-process/ 

British Academy Small Research Grants 

The British Academy, the UK’s national body for the humanities and social sciences, has announced that it is planning to issue a call for a further round of Small Research Grants on the 4th September 2013. Under the Small Research Grants programme grants of between £500 and £10,000 over two years are available to support primary research in the humanities and social sciences. Funds will be available to:

· Facilitate initial project planning and development

· Support the direct costs of research

· To enable the advancement of research through workshops, or visits by or to partner scholars. The closing date for applications will be the 16th October 2013. Read more at: http://www.britac.ac.uk/funding/guide/srg.cfm 

And finally, my massive thanks to the artist Sarah Lawton this week, who has helped me with a big NHS Modernisation project that I hope to reveal over the next few weeks.  

Thank you as ever for reading....C.P.

Finding a New Dentist

If you're looking for a dentist in Derby, you're actually spoiled for choice (unlike some parts of the UK where patients are forced to wait long periods for dental appointments). In addition to general dentists in the Derby area, you can find a whole host of cosmetic dentists, orthodontists, and paediatric dentists, together with a number of nationally recognised experts who specialise in areas such as oral surgery and periodontics.
There are currently 85 different dentists listed in and around Derby and, if you're prepared to drive for just 20 minutes or so, you can find even options available in nearby Burton-upon-Trent and Nottingham (both are within 15 miles). With so many dentists to choose from in the Derby area, many local dental patients can feel overwhelmed by the sheer choice available. In these situations, many people simply choose the nearest dentist, the cheapest, or one that a friend or family member recommends.
Yet with such a golden opportunity to find exactly the type of service you're looking for, it just doesn't make sense to go with the easiest option. By walking through the simple process below, you'll be able to ensure that you find the right dentist for you and your family, whether you live in the centre of Derby or in the surrounding area in Ashbourne, Belper, Ripley, etc.
In order to ensure you make a sound decision and find the best dentist in Derby, you need to do three things: 1. work out what you're looking for, 2. develop a list of prospective dentists in Derby, and 3. narrow down your list to just one or two dentists that you'll actually book appointments with.
The first step in the process is to work out what you're looking for in a dentist. Ideally the best way to do this is to sit down with a pen and paper for a few minutes and list everything that's important to you.
One of the main things to consider is whether you'd like to choose a private or an NHS dentist for your treatment in Derby. NHS dentists are typically cheaper than private ones and there are plenty of these available in the area (check the Derby NHS Choices website for a full list). As is other parts of the UK, there may be times when you have to wait to get an appointment with an NHS dentist, although this should be less of a problem in Derby than in more isolated areas of the country. Additionally, the range of treatments available on the NHS may be restricted, so this is something else to consider when you're thinking about your budget for dental care.
Once you've thought about whether an NHS dentist or private one would suit you better, the next thing to focus on is whether you are looking for particular skills or specialities from your dentist. These might include such things as specialisations in orthodontics or paediatric dentistry (for your children) as well as cosmetic dentistry, or dealing with nervous patients, if that is a priority for you. As mentioned above, you can find specialists from all of the main branches of dentistry in Derby, as well as a number of visiting specialists who offer appointments in the area on a regular basis.
Another section on your list of needs should centre on your lifestyle requirements. These can include things like the ideal location of your dentist (dentists listed as being "in Derby" may actually be out of the town centre in Spondon, Mackworth, Chaddesden, etc.) In addition to location, you'll also need to consider your schedule and think about when you'll most likely be able to see your dentist. Remember that traffic conditions can be bad in Derby, so make sure you're not being too optimistic about being able to make it to your appointment on time! There are a few dentists in Derby that are open late and at the weekend and this may help with scheduling, but this is far from typical.
Finally, as you come to the end of your list of needs, note down anything else that will determine your choice of dentist. Do you have strong preferences regarding facilities? Is the latest equipment an important factor for you? Do you need to be able bring in your own music to help you relax? You might also want to consider whether you're looking for a dentist that shares your attitude to health care. For example, you may be looking for a dentist that provides white mercury-free fillings and who prefers to limit the number of x-rays to the minimum in the interests of your overall health. Whatever is important to you, add it to your list here.
Once you've completed your list of needs, the next step to finding the best dentist in Derby is to create a list of prospects to choose from. There are three main ways of doing this: using the internet, checking the Yellow Pages, and asking family and friends. Of these, the easiest and most convenient is to use the internet. Choose your favourite search engine (Google, Yahoo or Bing) and look for listings of dentists in Derby, as well as additional information that may help you to make your decision (such as user experiences, reviews, etc). Also, have a look at any dentists websites that come up, as you'll also be able to learn a lot from these, although, surprisingly, many dentists in Derby don't seem to have their own websites!
Although you won't be able to find as much information as when using the internet, the Derby Yellow Pages can still be quite useful. One of the benefits of using the Yellow Pages is that it makes finding telephone numbers easy (for some reason, as well as lacking websites, it's also often difficult to find the phone numbers for a number of dentists in Derby when searching online! If you don't have a copy of the Yellow Pages for Derby, you can find lists of phone numbers on the dental directory and NHS sites for Derby.)
Finally, after checking the internet and Yellow Pages, it's a good idea to ask family, friends and other people you know about which dentists they recommend. This can be especially useful when you have particular needs (such as being a nervous patient, etc) and know someone in a similar situation. Good dentists rapidly attract positive word of mouth, so pay attention to what others are saying about their dentists in Derby. You might even consider travelling a little further out (past Mackworth, for example) if you hear of a particularly good dentist outside Derby town centre. One thing to be careful of, however, is assuming that a dentist will suit you just because he or she suits someone else: we all have different needs. After writing out your list of preferences, you should now be quite clear on what's important to you when looking for a dentist.
By now you're now ready to narrow down your list of prospects further to find the best dentist for you. There are several ways to do this. Firstly, consider the conversations you've already had about dentists with your family and friends. Can what you've already learned help you to cross some dentists off your list, or place others at the top? When you've thought about this, have a look at the dentists' websites and see what impression you get. You should be able to develop a clearer picture of what services they offer and what it's like to receive treatment there. If the dentist doesn't have a website, this process will be more difficult for you and you're going to have to call them or pay them a visit to find the information you need. As mentioned earlier, this won't be too much of a problem as almost all of the 85 dentists in the Derby area are within a half-hour drive of the city centre.
Before you contact the dentist's clinic, make a list of your questions in advance and check to see that you've covered everything from your list of needs. Use the telephone to prune down your list of prospects to the final few. When you've done so, it's time to visit the last remaining clinics in Derby to get a sense of whether you'd like to be treated there. Meet the team, talk to the dentist, have a look around and notice how the patients seem. Are they relaxed and in a good mood, or do they seem nervous? Together with the results of your earlier research, this step should provide you with information you need to chose one or two dentists for the final step in the process: making an appointment.
In the absence of comprehensive ratings system for dentists, the best way to determine if a particular dentist is right for you (or not!) is to schedule an appointment. This first appointment will probably just be for a consultation and a brief look at your teeth, or perhaps a simple cleaning. Use this opportunity to ask the dentist any final questions you might have and to get a sense of whether you feel you can relax with and trust the dentist. If at this stage you feel some misgivings or if there are any problems, it's better to move onto one of the other dentists from your list and schedule an appointment there. If, however, everything seems right and you feel positive about this new dentist then well done! It looks like you might have just have found your new dentist in Derby!
By following this process: thinking through your needs, developing a list of prospective dentists in the Derby area, pruning them down to the final few, and then getting direct experience of being treated by them, you'll be sure to find the best option for you, while avoiding the problems so many other people face when dealing with a dentist that simply wasn't the right choice for them from the start.

Quark for Health...

A small blast from Italy

What a week! I AM: Art as an agent for change has seen the fourth partnership meeting in Pescara, Italy. As guests of the Italian health agency, FeDaSerD people from Pescara and Pistoia in Italy, from Kütahya in Turkey and from Liverpool and Manchester in the UK have begun designing an artists exchange between the three countries which will see a series of artist led workshops, exhibitions and symposium exploring culture and the arts in the addiction/recovery process.

I am thrilled to announce that we will be working with some quite outstanding international artists who each in their own way, have ploughed a unique furrow. Ali Zaidi (UK) will be pulling all the artists together and his work around food and our eating together, promises to excite and engage and be invaluable to the collaborative process. Cristina Nuñez through her beautiful and provocative photography, explores self-portraiture, creative identity and self-esteem - particularly through moments of crisis. Selda Asal is a film-maker who enables people to tell their stories in distinctive ways, often people marginalized by forces seemingly beyond their control. Leon Jakeman is an artist who constructs work that responds to his own experiences, stripping away original meaning and creating new identities in the materials he works with.

Unique and challenging, all of them - but working together to explore just how the arts might be central to the recovery process. I’m pleased to say that building on our Manifesto for arts/health/wellbeing, I will be working with all the artists and partners involved in this work, to develop a European Recovery Manifesto to be launched between July and September 2014. Think bill of rights, think what it is to be human, think again that, “standing on the world's summit we launch once again our insolent challenge to the stars!”

A big thanks goes to Nicoletta D’Alosio for being such a wonderful and generous host and to Giuseppe (Joe) D’Abruzzo who was the kindest and most giving of friends, even with advice on my own fragile health! And a HUGE thanks to Dr. Giovanni Cordova and all at LAAD for their warmth (and food)...and of course, the indefatigable Mark Prest.

Getting International in Arts and Health

Artists International Development Programme

The Artists' international development programme is a £750,000 fund, jointly funded by the British Council and Arts Council England. The programme offers early stage development opportunities for individual freelance and self-employed artists based in England to spend time building links with artists, organisations and/or creative producers in another country. The next deadline for applications to the fund is 5pm Friday 4 October 2013.  Decisions made mid-November. Read more at: http://www.artscouncil.org.uk/funding/apply-for-funding/artists-international-development-fund/ 

Great Britain Sasakawa Foundation Grants Programme 

Organisations and schools in the UK that wish to develop links with Japan and Japanese schools are able to apply for funding through the Great Britain Sasakawa Foundation. The Foundation makes small grants to support activities that support the study of the Japanese language and culture, School, Education and Youth exchanges. In the past the Foundation has made grants towards visits the between the UK and Japan between by teachers and young people and the teaching and development of Japanese language and cultural studies in schools. http://www.gbsf.org.uk/

It seems that the Australian media (well the Sunday Telegraph at least) were right in their almost prescient front-cover, which I reprint here for the sheer bliss of sharing an oh-so-subtle, unbiased, politically neutral 21st century press. I am thrilled to be speaking at the 5th International Arts and Health Conference in Sydney this year between 12 - 14 November and hosted this year, by the College of Fine Arts, University of New South Wales. More details can be found by clicking on the Koalas below! To find out a little more about what I'll be speaking about, click on, fiction-non-fction.

On the joys of European working...

Driving from Pescara to Rome through the most outrageous landscape, I dwelt heavily on the week’s work. I’ve spent time with some remarkable people...exhausting, committed and wonderful people. My traveling companions this week have been a heady crew: Musical score by Bill Callahan (Smog), Knock Knock - Film and light entertainment provided by Frederick Wiseman, Titicut Follies and something light to read - Sarah Kane, Blasted and 4:48 Psychosis.

Melancholic by nature, I was lifted from my torpor and found myself near to hysteria by the strange charms of idyosyncratic translation. I’d recently been interviewed by the Turkish news channel, TRT - and probably talking much hyperbole and gibberish, they dubbed over me (if you speak Turkish, please tell me, what they said, that I said!!) So, throwing ego out of the window, I share with you a snippet of this interview and my new identity! Excuse the sweaty pallor and over-enthusiastic nature. Please note my full name and place in the universe.

Footnotes on Fundamental Cheese-Based Products...

A Quark is an elementary particle and a fundamental constituent of matter. There are six types of quarks, known as Flavours: up, down, strange, charm, bottom and top! 

Quark is a type of fresh dairy product, made by warming soured milk until the desired degree of denaturation occurs. It is soft, white, unaged and curd-like.

Good grief...C.P.

Psychiatry beyond the current paradigm

Last week Laura let me out of the office to go to this conference at Nottingham University organised by the Critical Psychiatry Network and Asylum Associates. It was perfect timing, as it meant I had the opportunity to see Jacqui Dillon speak just a week or so before she visits us here in Mid Wales for our own Shaping Services Together event on Thursday 19 September. 

I stayed for two of the three days and found all the speaker and workshop sessions immensely enjoyable. All stimulated some interesting and relevant debate, and I hope to pick up on some of the specific topics in future blog posts (for example, a workshop on an innovative Finnish approach called Open Dialogue, and Clinical Psychologist Steven Coles’ session on the dynamics of power).

Today, though, I just want to give an overview of the conference as a whole to give a flavour – and maybe tempt some local readers to pluck up courage to step outside the county and take part in an event like this – because there are increasing numbers which is great. I say “pluck up courage” because – I went on my own, I didn’t know anyone else before I arrived, and I was a little nervous about how it would be... two days surrounded by strangers at a huge unfamiliar venue (well everywhere outside Mid Wales seems vast)... and people who more than likely knew far more than I did about the subject – even the title of the conference was a bit off-putting! 

But five minutes after arriving at the venue I was deep in conversation with a woman from Wakefield about how difficult it is to find local groups in Yorkshire where people can share experiences about mental distress. And I was telling her about the peer support group based at Ponthafren in Newtown! (It’s a long drive though... better she sets up her own group in Yorkshire...)

The conference was promoted with this blurb: 
“Voices from within psychiatry who are seeking change are beginning to be heard. The Royal College of Psychiatrists’ leading regular publication, The British Journal of Psychiatry, recently carried a paper from the UK Critical Psychiatry Network entitled Beyond the Current Paradigm, which emphasises the importance of services and practitioners working with rather than upon those who seek their help. Perhaps unexpectedly, it received very little criticism from academics and peer psychiatrists.”

The first morning we listened to three keynote speakers, who started to explore this theme. Hugh Middleton (NHS Consultant Psychiatrist and also Associate Professor at the Nottingham University School of Sociology/Social Policy) began. He said that doctors of any sort only have authority to practice if there is clear evidence that it results in good rather than harm, and many now question whether psychiatrists fall into that category. The paper has “disappeared into a cloud of silence,” and Hugh and colleagues interpret that as “assent.” 

Hugh described how psychiatric drugs are trialled, summarising that all evidence to support the use of such drugs is flawed. The evidence around the benefits of psychological therapies is also possibly flawed – it is felt that if there is a positive outcome from such sessions this is down to the success of the supportive/nurturing relationship which is set up with the "client". Hugh said that we have to accept that sometimes something happens to people which profoundly disturbs them and/or the people around them, and that contemporary medicine provides no better solution than the demonisation or incarceration options of the past. He summed up his session by saying, “people want something different to what they get from conventional experiences. What is it? Let’s look for shared solutions.”

Jacqui Dillon followed, responding to the paper from “an activist position.” It is impossible to do justice to her presentation here, but some of the key points raised included:

• Biological (medical model) psychiatry is now trying to incorporate many of the approaches promoted by critical psychiatry groups, such as the impact of trauma on mental wellbeing. “But this is all about outcomes for psychiatrists – what about outcomes for ‘service users’?”
• It is assumed the doctors are the only ones able to do everything – psychological, social, medical – the lot. The message is: “you need us in charge.”
• Vested interests range through pharmaceutical companies, political parties to society in general, families and carers, some ‘service users’ and professionals.
• We locate madness in others – because it makes us feel OK.

So, what can be done? Some of Jacqui’s ideas to whet your appetite for next week:

• Reframe and reclaim ordinary language.
• Take a stand.
• Work in collaboration with people with lived experience.
• Help promote people’s voice.
• Lobby for change.
• Join a group with similar goals.

And what if we phased out psychiatry completely? What would the world look like then? Again, a few of Jacqui’s ideas:

• Develop non-medicated coping strategies.
• Create a range of self-help support (sharing books, setting up groups).
• Survivor-run crisis houses based on the Soteria model.
• Phase out mental health professionals and give basic skills to people – around active listening, being looked after, and sitting with people in distress.

This session was rounded off by Steve Trenchard, Chief Executive of Derbyshire Healthcare NHS Trust. His background is as a mental health nurse, and he said that he wanted to listen and co-produce solutions not yet found. There is “a need to focus on strengths and aspirations.” And he wants to develop ‘listening’ and ‘being with’ skills. 

Again, it’s very difficult to summarise in a short space, and Steve covered a massive range of areas in his talk, but at each point it seemed to me (and others listening as was discussed later) that his approach as a Chief Exec is extremely rare (even perhaps radical) and much needed. He considered new approaches to dementia care, schizophrenia, the use of physical restraint and seclusion rooms (including a pilot to close the latter) and our obsession with risk. He encouraged more self-control for people, which he considered the biggest factor in improving health, and spoke about the Expert by Experience programme – “no decision about me without me.”

Steve took inspiration, in part, from the past. He referred to The Retreat, set up in York in 1813 by a Quaker called William Tuke, a “supportive and healing environment” for people experiencing mental distress, as distinct from the inhumane and squalid asylums of the time. 

In Derbyshire it seems like things could be changing around services as professionals like Steve are listening to and responding to people’s experiences. I really hope that in Powys people who provide or commission mental health services can make that connection so that we see a shift here as well... And on that note, I look forward to continuing this discussion next Thursday at the Shaping Services Together conference at The Pavilion in Llandrindod Wells! See you there!

An update: Jacqui has kindly sent me her presentation and you can now read it here.