Why Kabul?

A good question - why Kabul indeed - what has this to do with English PD services?
There is a connection, but it is a bit tenuous - and it's probably better if Greenshrink explains it: www.blogspot.greenshrink.com

And finally... sent to Coventry

Nobody really knows why we say that - though the deliberate exclusion of people who have been 'sent to Coventry' must interest us in the PD programme (although we only have about 30 hours left of our existence). A little research into these matters (courtesy of good old Wikipedia) does again immerse us into the medieval history of middle England. The first recorded use of the term was for a 1765 fox-hunter who clearly did not have modern communication skills:

John Barry having sent the Fox Hounds to a different place to what was ordered was sent to Coventry, but return'd upon giving six bottles of Claret to the Hunt

Today, we managed just half a bottle of Cava in a cafe near the station, to celebrate the end of our trail. But the city itself was also famous as the home of Lady Godiva in the eleventh century, and for being a major area of inland devastation following World War II bombing in November 1940. But we were definitely not impressed with the spaghettoid nature of the ring road, and the way its intricacies were unsolvable by a sophisticated modern GPS with a sophisticated modern operator (who felt she was losing her sophisticated modern demeanour as we realised we were going in circles). But all was resolved in time for a punctual arrival and warm welcome.

The ship-shaped modern architecture intrigued us: symbolising modernity and careful control in all its internal arrangements (like artfully chosen framed pictures firmly screwed to the walls, soft furnishings untainted by six years continuous use, and and ever-more efficient use of limited therapy and administrative space). But the overall curved-and-straight lines of the building did make us think of increasingly fanciful analogies - of flexibility and control, chaos and order, soft and hard, feminine and masculine, yin and yang...  Perhaps they had already engaged the Feng Shui consultants.

After collecting our data (and being given a handsome sandwich lunch), we were shown round. The most irregular feature of the whole builing, we found, was the large bug-eyed dayglo-coloured fluffy cat sitting peacefully on the desk of a staff member who was away. When we learned that the cat was frequently flung around the building, or at least around the open-plan office, we were reassured that things were not so very different from anywhere else.

The photos for the blog were easy to choose and agree. The Olive Tree itself symbolises the beautiful analogy of needing to appreciate nature as it is, rather than demanding it be different; some of the paintings are used in the elegant brochure with which the service explains itself to outsiders; the masks symbolise the dramatic impact of the programme's psychodrama sessions; and the abstract painting in the reception area, we were convincingly assured, was an angry portrayal of Kermit the Frog.

STARS alight!

Thames Valley Initiative, being one of the bigger projects, has split into several different since its origins in 2004; some by design and others by the inevitable processes of NHS changes like Foundation Trusts. The 'TVI' team was formed as the 'umbrella' to integrate and coordinate the clinical services across the region - mainly now through service user partnership.

Meeting in Aylesbury was therefore somewhat artificial - as the team covers the terrain between the far-flung corners of the Berkshire Downs with the horsey lands near Lambourne, Royal Windsor and its less leafy suburb of Slough, the concrete cows of modern Milton Keynes and the sleepy Cotswold villages of rural Oxfordshire.


But one of the first things we noticed - as often - was the warm welcome. About 28C by the feel of it. Many of us are used to NHS hospitals where the blazing heat of the radiators comes on in October and goes off in March, come what may - but the system seems even more perverse in Aylesbury, where - if we heard it right - this was in reverse. And, having the usual level of environmental and practical control that NHS employees enjoy, we were confidently assured that there was nothing  that could be done about it. Perhaps a sort of symbolism for the limits to empowerment? Or a challenge for those who are sufficiently determined?


But  the insufficiency of the partially-openable mental health windows to counter the intense blasts of radiant energy emanating from the self-empowered and autonomously functioning radiators was a fact we could not ignore for long. The levels of oxygen felt disablingly low, and fresh air breaks were called for. For some, of course, this is a paradoxical injunction and the 'fresh air' required is charged with mixed carcinogens, particulates and tar - but only allowed if undertaken beyond the boundary, in the public road. But sometimes, the best conversations happen in "smokers' corner"...

 

(Stars logo, and other pics, awaited...)

The Great Brain Robbery

Aylesbury isn't known for much, but had a few minutes of fame in April 1964 when the great train robbers were tried at Aylesbury Crown Court. It was the largest value robbery ever in the UK, and was so because it was just after a bank holiday weekend in Scotland - meaning the second carriage of the train, the 'high value package' sorting office, en route between Glasgow and London Euston, contained £2.6m in used £1, £5 and £10 notes (and after a normal weekend this would only have been £0.3m). The robbers stopped the train at 3am by covering the green signal and making the red one light up with a 6v battery they brought along with them. The judge described the robbery as "a crime of sordid violence inspired by vast greed" and passed sentences of 30 years imprisonment on Ronnie Biggs and several others. Ronnie Biggs escaped after 15 months and spent most of the rest of his life in Brazil, though he returned to the UK in 2001 for healthcare and a pint of bitter - and was re-imprisoned though later released on compassionate grounds. 


This resonates (slightly) with our travels to Aylesbury today, as it is the most inconvenient town to travel to from near and far. For one of us, it was a disproportionately long train journey from London (presumably with better signals now); a gruesomely early start for another's car journey, and a triangular-shaped car journey from not very far away for the last (but one which passed very close to the robbers' hideout, not that that is much compensation).


First we had the security system to get in - presumably to reassure us that we were in an environment where nobody was allowed in or out without all the necessary permissions and contestable authorisations to be allowed to talk to each other. Then there was the decor: going beyond the phase of battleship grey or suburban magnolia that graces many NHS mental health facilities, the inhabitants of this meagre corridor had clearly had some control over the colour of at least one wall in each room. We were invited to set up our base camp on turquoise NHS-standard issue soft chairs in a room with a green carpet and a solitary purple wall. Student accommodation? First Great Western rolling stock? A night out clubbing? Never mind, we thought - at least it didn't feel like a hospital.


The central hub of Buckinghamshire's complex needs services has lived in this single short corridor since it started in 2005 - and there has been one triumph of architectural planning and one disaster since then, we were told. The disaster is that the planners of the new soon-to-be-commissioned mental health facilities building did not really understand the specific requirements of an intensive psychosocial treatment programme, and has only one room allocated for the purpose, which is therefore useless. So the service is likely to remain in its minimalistic faceless corridor for the foreseeable future. But the good news, the triumph of the corporate mentality, is that a single loo has been converted into a double loo. It is noteworthy how many staff proudly told us this - I even lost track of whether they were being ironic. 


Even odder perhaps was the sign on the outside of one of the two loos: "The Gordon Gunnarsen Centre for Expressive Dance". This conjured up fantasies of balletic movements around the pan, strange Reichian bodywork therapy in confined spaces, and no doubt other less seemly activities better kept confined to the private spaces of our imaginations. But, whatever, else we have resolved to never use the rather coarse 'going to the John' euphemism again, but replace it with the much more gracious 'need to see Gordon'...


Shortly before leaving, we were much intrigued by an aphorism related to us by a senior staff member, which seemed to say something important about the day:

"I think of my mind like a bad neighbourhood. I would never go into it alone"

The photo question was answered almost as soon as we mentioned it: the 'Faith Lunch' table (the magnificent spread which all members of the group had brought in to celebrate a staff member's last day), the plaque in the large group room, the mesmerising carpet in the centre of the circle of chairs, and a 'split personality' painting which one of the members (not attributable) had done some time ago. 
We understand, from various conversations apart from today's, that the patterns of the carpet can be a very useful diversion during the parts of the group therapy when exploring them can be more immediately satisfying than joining the group discussions...
So here they are:

. 

Quite a large potato

Every year for the last eleven, a few dozen researchers, clinicians and various others have gathered for two or three days of serious talking (and some less serious talking, too, as well as the other things people do at academic conferences). It was first held as a one day event, a brainchild of the most senior researcher in the field, who also happens to be the most prolific instant composer of rhyming doggerel in the Kingdom of Psychiatry: Professor Peter Tyrer.

Under Peter's early presidency of the emergent 'British and Irish Group for the Study of Personality Disorder` (aka BIGSPD), the emergent organisation had its annual jamboree in Jersey, Eire and Wales. In keeping with the  imperative to avoid exclusion, he has since lobbied for a meeting on the Isle of Man - but BIGSPD's new democratic processes (such as having a committee) have rather thwarted the idea.Others seemed somewhat opposed to the principle of any support for a regime which allows the flogging of its citizens for crime. Clearly not behaviourists, then. But I did wonder if it's more to do with having cats which look as if they have had their tails cut off, or wasting fossil fuels on extreme motor-bike races.

But this year, it was Oxford's turn - with Lady Margaret Hall providing the venue, and two Thames Valley consultant psychiatrists, Steve Pearce and Rex Haigh, being the local organisers. It was their intention to build on recent trends such as the increasing participation of service users, to include disciplines other than just psychology and psychiatry, and for people to have an unacceptable amount of fun (in such austere times). Any comment or analysis about the extent to which they succeeded will be left for respondents to this blog, but here are a few personal highlights which were appreciated by Bodd:

• Sunshine. Every day - on college lawns, with spring flowers and amidst gracious Oxbridge courtyards.
• A workshop session with Oxford and Wallingford Therapeutic Communities, demonstrating how they worked, but also giving the participating staff a hard time with their questions back about how it all works and why on earth they should want to work with 'people like us'. One answer was 'because ordinary people seem boring after working with you lot'.
• An opening lecture from Joel Paris, a distinguished Canadian psychiatrist from Montreal, who was advocating that mental health should be thought of more like RD Laing did, than our professional organisations or indeed western governments do nowadays.
• A Hog Roast with a marquee in the college gardens, not much enjoyed by the numerous vegetarians and vegans, whose alternative nutrition ran out - leaving several of them hungry. Despite this, no vegetarians were spotted changing sides. Perhaps unsurprising.
• A dazzling lecture by a Oxford philosopher, Dr Hanna Pickard, Fellow of All Souls College, who showed everybody that Aristotle had the problem sussed out over two thousand years ago.
• After dinner entertainment from Jo Brand, who is fortuitously related by marriage to one of the Oxford TC staff team. Particularly illuminating were her insights into how criminal justice and mental health systems interacted in South East London about twenty five years ago. How we hope things have changed a bit since then, and we might manage to change them a bit more yet...
• A wierd and vertigo-inducing rip through the last ten years of government policy for PD - with a slide show as upsetting as one of the nasty rides in a theme park, and people from the government team shouting at each other across the lecture room. With Peter Tyrer spontaneously pretending to be an American visitor at a funeral. Like a spiritualist revival meeting? But at least there were lots of picture of me (in my various mood states) on the screen.
• A debate about whether pictures of the brain tell us anything that matters. A German woman put up a picture of what goes on in an English brain, and it drew much praise. Enough said.

Leeds to follow

The trains today all worked so smoothly, without any heated exchanges with revenue protection officers or fights with automatic barriers, that we had the impression something must be wrong. On my own journey, I was interested to hear how three young Yorkshire lads, talking broad Barnsley, could talk continuously, with great excitement and passion, all the way from Birmingham to Leeds (a journey time just shy of two hours) about a single game of football. The detail was flabbergasting – who should have been substitute at the 38^th minute with a fully argued case about all the options, the geometry of somebody’s pass to somebody else, such-and-such a player’s ligament problems - and on and on it went. I couldn’t help but think that brains with that sort of retentive and analytic capacity could be put to better use…

Anyway, we were all on time – and met at the station entrance (no pigeons, but no gracious deep red brickwork either, see Nottingham last week). We bundled into a taxi and arrived fresh and ready for our 1130 start. The taxi back was a slightly different story, as the driver was determined to listen to Jeremy Vine interviewing Director of Public Prosecutions Kier Starmer on Radio 2 at about a hundred and twenty decibels. This did not fill us with joy: a professional colleague has been known to claim that this particular interviewer makes ridiculously inflaming statements and puts deliberately stupid questions with the intention of having a negative and destructive influence on his devoted listeners. So through gritted teeth, with admirable restraint and due assertiveness, one of our number told him to turn the bloody thing down (paraphrased), so we could hear ourselves think, and get on with our usual debriefing. With strangely speedy obedience, he did so. We then had a good old argument between us about which BBC radio station is best - but for me, it has never been the same since John Peel died a few years ago, several decades too early.

The Leeds Managed Clinical Network is renowned for the way it started ‘doing PD’ about three years before the national programme started – and by that time had a considerable array of service users, senior managers and commissioners on board and keen. It was interesting to be told that they still live and work in rented accommodation in several areas of the city – and don’t have anywhere they can call home. Today’s meeting was in Unity Court, which must be in an up-and-coming part of town (about two miles north of the city centre), as only a few months ago Waitrose had opened up an upmarket supermarket there. It is where the network’s offices are, and where there is a large training room for meetings, in which we had half a dozen plates of biscuits and onion bhajees laid out for the service users and a circle of about twenty-five bright purple chairs laid out for all of us. Interestingly, we were being watched by as many pairs of eyes staring out from the framed portraits which almost filled one wall – all dressed in smart suits and with gold chains and impressive-looking seals of office dangling from them. When I expressed my curiosity about all these severe people looking at us, one of the locals explained that ‘it was a northern thing’. Apparently the building belonged to the ‘Oddfellows’ (which does include a few women in the photos, similarly attired). With minimal Google effort, I learned (mostly from the local paper) several interesting things about the Oddfellows of Leeds, and elsewhere:

• It is a 'thriving social organisation' whose roots can be traced back to Roman times 
• Its roots can be found in the Middle Ages as a workers' counter to powerful masters' trade guilds.
• The society's ritualistic symbols are seen in a plaque which presented to freed slaves by Titus Caesar.
• They provided their members with support in times of illness or hardship.
• The organisation's official title is The Independent Order of Odd Fellows Manchester Unity Friendly Society, and it was founded formally 200 years ago. It had its former headquarters in Leeds.
• Long before that, it survived an attempt by Henry VIII to wipe it out. 
• Their earliest recorded lodge in Leeds, the Loyal Mechanic, was founded 1826, and still has regular meetings. 
• In Victorian times, the organisations became friendly societies and they flourished across Britain.
• It has 2,500 members in the city of Leeds.  In 1844 Leeds had 95 Lodges with 7,434 members.

So it's hard to work out whether it really is 'a northern thing' - their website mentions groups as far flung as Ipswich and Truro, London and Hartlepool. But at least we now know who all those people, staring from their frames in all their finery, were (and are).

Then there was the question of our own photo – which also proved to be a bit more difficult than expected, due the fact that this home of the Oddfellows wasn’t a place that any of the service users knew. It therefore held no memories of anything for them, nor any special meaning. A few suggestions were made, such as the ‘agenda’ for the Diverse Pathways weekly programme – but the only thing that everybody could agree on was the staff. And the ‘real staff’ – not ‘just those who sat in offices’. This idea soon evolved into more than just a simple photo, but a web of staff photos connected by network lines. At this point the hi-tech nature of the request, and the waiting taxi driver listening to his Radio 2, defeated the visiting team. So in true KUF and PD therapy style, we handed the responsibility back to the group: one service user and one staff member will arrange for a suitable photo (or photos) to be sent in to us. And as soon as we get it, it will appear here; until then, you can have a picture of us!

Mandala Madness

Nottingham station always struck me as quite a gracious architectural statement of northern civic decency (it’s northern to us soft southerners, at least): with its fine high vaulted ceiling, modest Victorian embellishments and deep red brickwork. Nowadays, as everywhere, it gets the usual commercial overlay – with newsagents selling cheap beer, ticket offices with fair queue systems, and the coffee cabin chains. Its coffee cabin shop is between the two entrances from the carriage yard, with all its tables and chairs right in the middle of the fine parquet floor. But my colleagues were on trains which arrived a few minutes before mine, and they did not agree at all with my soft-focus impression of the local civic good taste. In fact, although they had sat at one of those tables – beneath the high glass skylights on the elegant parquet floor, for a quiet morning shot of caffeine, by the time I arrived they were on their feet, quivering by the door, muttering darkly about hygiene, pointing accusingly skywards and clearly not enjoying the architecture. In fact, they had been evicted from their table by unwelcome feathered companions – who were nibbling at pastry crumbs and generally oblivious to the fact they were not wanted. Often called ‘flying rats’, or similar, and thought to harbour a vile range of high-risk pathogens, a quick exploration of Wikipedia suggests that this is an unfair attribution – and people’s aversion to these flying city-dwellers is more likely to be psychogenic and aesthetic in origin. Sudden dives from above, startling flutter of wings, no manners or social graces, and an unpredictability of action that just doesn’t fit with the modern expectation of certainty in all things. Come back, Daphne du Maurier and Alfred Hitchcock – us southern softies need a bit more randomness in our lives!

The Mandala Centre started its life as a mental health unit in the 1960s when two analytically-minded psychiatrists (with Jungian leanings) set up a community unit there, in the days when very little mental health took place outside the asylums.  It overlooks ‘The Forest’ which is a wide and open green park area between Nottingham’s red light district (in Forest Road, high up and overlooking the Mandala Centre from the opposite side), and a richly diverse area called Forest Fields behind it. For about a week every October the whole area is transformed – by a fifteen foot white bird who proudly stands on the busy Mansfield Road roundabout: it is for Nottingham Goose Fair. With some claim to being largest and/or oldest traditional fair in England, where several travelling fairs come together for the last event of the season before winter sets in, it’s just about possible to imagine everybody from all around driving their geese for the pre-Christmas sale. If the farmer puts his right arm out, the geese veer to the left, and vice versa. In fact, geese imprint more strongly than any animal, and if they see their owner soon after hatching that owner will always be parent to that good gosling, and later goose. So selling them all off at the Goose Fair must have been an interesting study in disrupted attachment… But now it is now a blaze of light, a cacophony of disco-noise and a fragrance of fried onions and candy floss, with seriously scary fairground rides and the vibes of high-energy sleaze and yoof at play. As well as the gang warfare and occasional knifing, for which Nottingham is unjustly famous.

Presumably the name Mandala was then chosen for its flavour of eastern mysticism, and Jung’s use of the concept. In fact, when the building was allocated for use by the new pilot project in 2005, the name was seen as particularly apt by the project leaders:

The word MANDALA is from the root MANDA, which means essence, to which the suffix –LA, meaning container, has been added. Thus you could say that Mandala is the container of essence.

As an image, a mandala may symbolise both the mind and the body. Carl Jung became interested in mandalas while studying eastern religion and he saw the circular images his clients experienced as “movement towards psychological growth and representing the idea of a safe refuge, inner reconciliation and wholeness”.

Since setting up in 2005, the service logo has always been a brightly coloured version of Jung’s own drawing of a Mandala. This was also made as a large mosaic on a circular board, which was attached to the wall in the main community room. Since then, people who have left the programme have made small mosaics to go all around it – and this is the picture which the members and ex-members of the Mandala Centre’s programmes asked to be included in the blog. So here it is:

Breaking Ice in The Zone

For some reason, our journey to Plymouth took on the qualities of an epic journey to the wild west for the three of us - and it felt a very long way away, as if to an alien land (even stranger than south London, see 18 January). So we all prepared for the major trek in different ways, to make sure we would be bright eyed and bushy-tailed for a 10am start on Union Street - just off the main drag (called 'Armada Way') between the station and the Hoe. Maybe it was unconscious thoughts of Sir Francis Drake and his rather more impressive journey to Plymouth that so elevated it in our minds.

Without giving away trade secrets (or our names), one of our number exhibited excessive safety behaviour; one made good for an altercation with a railwayman about a missed train (and excess fare) in Cambridge last week, and the other was frankly exhibiting reckless behaviour worthy of a formal risk assessment.

The safety behaviour was allowing many hours 'hanging around' time to be there almost a day before it was strictly necessary, and booking to stay in an unnecessarily dull and corporate hotel. However, it did mean that it was daylight for that spectacular part of the journey west of Exeter, between Dawlish Warren and Teignmouth - where the train seems to be flying along the beach, almost lapped by the waves amidst the dog-walkers, and periodically diving into holes in the bright red cliffs - for miles and miles. In fact the train arrived at Plymouth with so much time to spare that it required a brisk walk round the Hoe and the Barbican areas to stave off boredom. But the sight of bare-chested young men 'hanging out' on the Hoe, and the release of several dozen purple balloons at dusk, by young folk with mohican hair arrangements, soon prevented any likelihood of that. A good curry nearby, amidst all the monumental architecture of England's glorious naval heritage, also helped stave off torpor.

Possibly the most sensible preparation was by the one of our number who arrived in the evening and had arranged a place to stay in a friendly B&B. But this was in contrast to last week, where extraordinarily lucky train connections and arrival without missing much were later counterbalanced by the team's excessive need to talk - resulting in a missed advance-price-ticket train with a mean penalty. But at least things were better in Plymouth! It does mean that none of us has now escaped the new-found ferocity of the railways' Revenue Protection Officers. Once upon a time it would have looked quite unnecessarily transferring resources back from one bit of the national infrastructure (the NHS) to another (the railway) - but we now live in mean and lean times.

The final member of the team decided that it was the perfect opportunity to make use of the excellent facility provided by the Paddington to Penzance sleeper train - leave London after a day's work and an evening at home, then have a good rest and sleep to the gently rocking rhythm of an inter-city train. What was not taken into the initial calculation was that the seats were not as conducive to shut-eye as the cabins, and that not everybody on such trains quite understands the word 'sleeper'. An exorbitantly tall man with a German accent talked a great deal, then decided to lie under the table to go to sleep. It was rather mystifying, and quite possibly sinister, to become half-aware that he had disappeared somewhere west of Taunton - how could his considerable frame have slipped under the seat? Or should Miss Marple be called? The other consideration of hazard was that a train scheduled to arrive in Penzance at 0759 actually arrives in Plymouth at 0513: and there is not a great deal of entertainment to be had at Plymouth station at 0513, nor in the town nearby. In the dark. And in the pouring rain. And just who might one meet then?

Nevertheless, we successfully met about half an hour before the appointed time, and found a cafe near The Zone to gather ourselves. It did have black tablecloths and a quite unique ambience - but the staff there were very friendly as well as interestingly attired, and we felt all the more energised by the Bohemian vibes.

The local youth are quite cool and casual about attending The Zone, we were told, because it's where everybody goes to get the free condoms. Even though we were all at least double the age of their clients, we were warmly welcomed - didn't feel our age at all - and were led through the warren of municpal corridors and staircases to the Icebreak offices where we started the work of the day. Thankfully, caffeine was offered rather than condoms, and it was much appreciated.

The photos chosen reflect some of the conversations - but also capture some words which were felt to summarise something important about the place.

The Manzil Way to Cowley Road in Oxford

This was the second visit of the day - Reading in the morning and Oxford in the afternoon. The road between the two was about an hour's struggle through all the pretty Thames-side villages with synchronised speed cameras, and the train was 25 minutes non-stop. A no-brainer, as they say. The only snag was the rather intimidating car park at Reading station where you have to purchase an unusual-looking token without which it is presumably impossible to escape (see Tuesday - 'controlled access'), by car at least (see earlier today - lots of lovely places to go by train).

But after that slight anxiety, the first thing we noticed was what an easy journey it was - ticket to platform to train to helpful refreshments trolley person - to taxi - to Oxford Complex Needs Service. Even time for a breath of fresh air before we went in, which we did exactly at the appointed time. The refreshments trolley person on the train was particularly impressive - after missing her whizzing past first time round, she said not to worry as she'd be back. When we were ten minutes away from Oxford station we had given up, and resigned ourselves to a couple more biscuits and a hungry afternoon - but no! Nine minutes before arrival, she was there again, all smiles and selling us a quite tasty looking sandwich and bean salad. Bean salads are a bit difficult to eat with your fingers, but thank goodness for M&S foodstores on station concourses - free forks!

Negotiating the door entry buzzer and rampant cheese plant foliage in the entrance was quite easy (I remember a colleague used to say that the best way to instantly assess the overall health of a psychiatric unit was to look at the plants), and we were offered coffee, and everything else we might need. The building was NHS, but free of most of the signs of over-institutionalisation - and we had the  first hour in an office and the second hour in a large comfy room with several sofas. I often think the presence of sofas says something important about the prevailing attitude in a workplace - but it's hard to say exactly what it is, except that when I recently heard of the exact opposite (meetings without any seats at all - to keep everybody sharp and focussed, and maybe awake), it seemed obvious where it would be nicer to work.

Oxford seems to be one of those places where odd coincidences happen - maybe some ley-lines cross there. When we were walking out for our debrief, one of us in the visiting team met a long-time colleague and friend who lives in Surrey and was on his way to work in Hereford via a synchronous visit to an adjacent building in this colourful and lively part of Oxford. Such weird coincidences must mean something...

For our debriefing, one of us was keen to introduce the others to the delights of the 'Excelsior Cafe' over the road - which is possibly the most authentic 1950s 'greasy spoon' experience available in England today. Sadly the staff at the unit got wind of this and started to describe it in most unfair terms, such as 'an inch layer of grease on top of your tea' - and the visitors chose a much more respectable coffee bar close by. But by now it was after 6pm, and at least they served beer!

The request for a photo was a bit more complicated than usual, as three different groups of service users who had never met each other came together - with two of them from far-flung corners of Oxfordshire. So each of the three groups has been invited to send us a photo of their own TC, showing what they would like to convey about it, with a few notes. They will be put here as soon as they arrive...

Where is the Gnome of Winterbourne?

Those who don't know the ancient Royal County of Berkshire's capital often find the traffic system and ability to park rather baffling. The trains are so much easier - and one of the DH team has been know to say that the best thing about Reading is the station, where one can so easily get trains to fascinating places like Penzance, Carmarthen and even Scotland - and so escape from Reading. A town which was once, and probably still is, renowned for shopping, clubbing and fighting.  But if only those trains had all the personal comforts that every car now has as part of the standard kit. When the carriages come fitted with integral bluetooth connectivity, acceleration for 60-80 before you get to the next station, and double-fleece lined airbags, then public transport will start to claim the upper hand. But, as they say, one reaps what one sows. And today that included a horribly early start for members of the visiting team, and an anxious time hoping that the two hour parking zone would extend to three, as the discussions were too involved to get away exactly on time.

Another cars-in-Reading story very directly affected those at Winterbourne recently: a thief stole a car from just up the road and drove it off in something of a hurry. Unfortunately, he (or maybe she - but less likely) had rather a struggle to get the steering lock off. So s/he did not manage to deviate from the Newtonian principle of 'everything carries on in a straight line at the same speed unless acted upon by a force'. Unfortunately, the force that eventually stopped this runaway vehicle was the very solid hundred-year-old eight foot brick wall surrounding the centre's small garden. And that is where the car ended up, stationary at last. After many months of protracted contractual and insurance processes, the wall - and the garden within - were rebuilt. Hence the photos below, which the service users chose to have as their photo of something they wanted to be recognised.

Winterbourne's garden after rebuilding the wall

Unfortunately, there was a stronger but unfulfilled wish to have a photo of the Gnome of Winterbourne.

But this could not be found in the garden, and although there were rumours it was somewhere in the house - these could not be confirmed by the visitors.

Could this be who we are looking for?

If any members of Winterbourne would like to put the record straight - we promise to add the photo below, if you send it to us (we left our email details).

The quality of the biscuits ('decent shortbread') and coffee (freshly brewed) was noted favourably - especially as one member of the visiting team, with two very small children at home, was in great need of heavy caffeine doses.

The building caused some confusion - and although not exactly 'squashed olive controlled access' (see Cambridge, from Tuesday), it did have other more subtle ways of preventing visitors from leaving. One was to lead them from room to room in an effort to disorientate them, then to have strange twisting corridors leading nowhere when they tried to get away. The other (please forgive the indelicacy) was the loos. One was found hidden down a scary wood-panelled narrow staircase into the bowels of the building - where one could have well met a ghoul, or vampire or ork on the way; the other was up a strange curly staircase to another dead end corridor - with an oddly large loo at the top of it. Perhaps it is no surprise that accessibility requirements are demanding that the service moves to less haunted, or strange, premises.

The Complex Case of Cambridgeshire

The sun shone as we converged like the winds, from southeast, north and southwest, although the north wind had a little trouble with a cancelled train at Leeds - though still managed to arrive less than ten minutes late.

Greeted with warmth and hospitality, as well as coffee and tea, we arrived a few miles outside Cambridge on the site of the old Ida Darwin learning disability hospital - which is now a collection of similar looking low-slung brick buildings housing all sorts of different parts of what constitutes a modern mental health service. The once proud and renowned Fulbourn, a major epicentre of the 'unlocking the wards' movement of social psychiatry in the 1950s and 1960s, is now the trust headquarters about a mile away. It was explained to us how the locked wards are now not locked, but are described as having 'controlled access'.

Interestingly, this controlled access comes at a price: staff have small electronic gadgets (black plastic - about the size and shape of a squashed olive) on their key-rings, without which they can go nowhere. Indeed we had to have an official squashed olive carrier with us wherever we went. But we were told that the price of squashed olives is very high - at about £185 each. The squashed olives themselves only cost about £35, but it is the reprogramming of them that bumps the price up. So woe betide anybody who loses their squashed olive!

Interestingly, the whole-county foundation trust which runs it all is learning all it can from the experts of Arizona about 'recovery', and is doing everything it can and should to ensure that it is doing it properly.

We were reminded from time to time that the whole unit was in a state of temporary turmoil, while refurbishment work was being undertaken to construct a 12-bedded ward (controlled access) as an expansion of the service. Perhaps most curious was the fact that a monumentally extensive network of rabbit warrens lies underneath the building works. Apart from whimsical recollections of Chas and Dave, for when the rehoused service needs a team song, thoughts come to mind of the potential underground traffic in both directions. Fluffy bunnies appearing unexpectedly in the midst of art therapy, or gym sessions, or (heaven forbid) the group's cooking sessions - but in the other direction visions of the final scenes of the Sound of Music or even Colditz - overcoming the most controlled access of all!

Continuing the small furry animals theme, one of the rooms where we were offered space to meet people was called the 'hamster room' - though try as we might, we could find no sign nor trace of a single hamster. When we enquired further, we learned that one of the senior staff, on first entering the room, said 'this room smells of hamsters' - and the name stuck. Difficult to work out quite what the lesson is there, but I'm sure there is one!

However, a real animal that we did meet was a small pretty dog - which was sat on the group room sofa when we arrived. It seemed a rather lovely example of how therapeutic people find their relationships with animals, particularly when humans have often failed them. But we suspect that somebody thought it wasn't suitable for dogs to be present when 'the Men from the Ministry' were visiting, so we did not get the chance to make his or her acquaintance before he or she disappeared from the scene - which is rather a shame as the dear thing seemed to be an ideal subject for the 'what would you all like as a photo on the blog?' decision.

But it was not to be, and a picture of the Life Space room, plus a fairy with enormous wings, and the vibrant corridor mural were chosen instead. And the cakes we were offered (but sadly declined!)

IMPARTing innovation in NE London

South London is one thing (see 18 January), but the land beyond the East End – which merges imperceptibly into deepest Essex – is another world entirely. The trains are a funny shape, you have to fight through swarms of commuters coming the other way to get to them, and they go from a part of Liverpool Street station that is kept away from public view, and go through bleak lands with the enormous construction works for the 2012 Olympics. And the signs said ‘Shenfield’ is at the end of the line – just what sort of name for a town is that? ...and where on God’s earth is it? It sounds like a cross between Sellafield (see yesterday) and Highfields Happy Hens (greencare).

Goodmayes is one of those hospitals like they don’t make them any more, in true Victorian county asylum style. The front entrance is straddled by two foundation stones – one saying that the building was started in 1898, and one celebrating the opening in 1903 – by the mayor of West Ham. Apparently, it will not make it far into its second century, as it is likely to be demolished for development in the next few years.

Perhaps I was unwittingly wise to have arrived on my Brompton – as the car park can hold unpleasant terrors for those who choose to drive there – particularly the owners of swanky cars, and other petrol heads and Jeremy Clarkson fans. Some while ago, a 'hospital guest', who was detained at the pleasure of the Mental Health Act Commissioners, decided to make some sort of protest against all the cars in the car park – and kicked all their doors in. He did it quite calmly and methodically, and then went back to his ward to sleep off all the exertion. The local police made an impressively spirited response – turning up in a fleet of five vans, each full of suitably qualified officers – to mount an exhaustive investigation. Numerous photos were taken, measurements made and people interviewed. Sadly though, it does not seem that anybody gleaned much idea of just what the protest was about. But we can’t expect police officers to be psychologists, can we?

We were warmly welcomed with tea and cinnamon cakes, and shown the colour coded highlights of the premises: a purple room for one of the project leaders, and a yellow room for the other. One of whom was interestingly described as being like ‘a satnav with the voice turned off’. The yellow room had a fish tank, excellent for mindfulness we were told, with three inhabitants: ‘brownie’, ‘cup cake’ and ‘éclair’. The previous occupiers of the tank had the interesting names of ‘fish’, ‘chips’, ‘salt’ and ‘vinegar’. It doesn’t take much imagination to think what might have happened to them – though you’d need a few loaves to feed the five thousand, if you’re starting with four goldfish.

It was too difficult to choose a single photo to portray what the service users were proud of, so they chose four: a kettle to represent the ‘help-yourself’ way the kitchen is run; an owl for wisdom, a soft animal toy for comfort in times of stress, and a remarkably effective cross-stitch of a horse (in black and red – significant colours) made by a member of the group.

317 miles north

Our first impression of the Cumbrian Innovation Centre for PD was that it is a long way away. In fact Carlisle station (where we gathered) is just eight miles from the Scottish border. And that of course means more nowadays than it has done for several hundred years. In fact, on our journey out from Carlisle towards the Irish Sea, beyond the green acres of grazing sheep, we could see across the Solway Firth – at the end of which Hadrian built the western end of his enduring boundary between us and those people further north. 

Aspatria (pronounced eigh-spart-rya) was our destination, and we were whisked away, via Tesco’s car park next to the M6, for the 40 minute journey by car. To the town’s thriving rugby club. Once we arrived, our first observation was that the general idea that the north is colder than the south was not supported: it is quite clearly a great deal colder in Essex than in Cumbria. The first of several myths we were to explore…

Apparently, some people in these parts still worship the God Lug – from whom the ancient city of Carlisle took its Roman name, Lugovallium. Indeed the Romans, for all their faults, were quite tolerant in adapting to the tribal customs and beliefs of their northernmost outpost and in recognising the local importance of dear Lug. Myself, I am rather more suspicious of how Hoffman-Le Roche managed to bring a very similar word into everybody’s language in 1963.

After Roman times, the ancient kingdom of Rheged held sway in this corner of England: its boundaries are very similar to modern Cumbria. But before ‘Cumbria’ was invented in 1974, this area was largely Cumberland (in the North), Westmoreland (to the South) and parts of Lancashire (around Barrow-in-Furness). However, 1974 is quite long enough ago for most – and in the recent NHS Foundation Trust merger to cover mental health in the land of Rheged, few in the less populous south, who were happy with and used to their cultural practices and tribal rituals, saw it as a glorious return to the days of Rheged.

A more recent local tradition, dating from Victorian apprentices being paid at the end of every week, is ‘blackeye Friday’. This is the last Friday before Christmas, when all the vigorous young men of Carlisle had wages in their pockets, beer in their bellies and aggro on their minds. Hence there was a statistically significant increase (no reference available) in the number of black eyes in the homes and streets of Carlisle on the Saturday before Christmas. The visiting team understands that, to this day, one needs to proceed with caution down Botchersgate on that Friday before Christmas. But then, like many English towns and cities, many people choose not to proceed down pub-filled streets on any Friday or Saturday night, more than a century later.

We gathered one rather more compassionate story on our travels, albeit one with an unhappy ending. Farmers in these parts are said to be of a generous and kindly nature: after a new-born lamb was failing to feed, a visiting family were happy to be given the task of bottle feeding it to good health, which it soon regained. On planning to return, the farmer gave them the young lamb to bring up themselves. Unfortunately, their other responsibilities meant that this became impossible after a while, and the lamb was returned to the farmer. Although no certainty can be established, it is most likely that mint sauce and roast potatoes were its next companions.

And, without wanting to draw any inferences or conclusions from it, we were interested to hear that the largest stable employer on the coastal part of Cumbria is the Sellafield nuclear plant, where many sensible and professional people work, and live nearby. Unfortunately, we could not get the image of Homer Simpson and the family (and more widespread social) psychopathology our of our minds as we thought about Springfield-in-Cumbria.

As usual, we asked  our hosts to think of a photo that they would like to have included on this blog. The answer was clear, when we came to the end of our proceedings: "the view over the countryside which we can see when we do our art therapy". So here it is:

Now, to be fair, I'm not sure this is from the angle the group intended - and we had a discussion about sending us a photo that you've already got - so do ask if you want a different one here! (and make whatever comments you want, below, as well - please)

***UPDATE***

Today, a day later, we have received three photos that our Cumbrian colleagues wanted to be included. Here they are:

Heavenly Haven

Leaving the house, I felt that something wasn't quite right as I cycled off to the station. I discovered, when I got there and looked at the indicator board, what it was: I hadn't reset my alarm after yesterday's early start - and was an hour early. Undeterred, I had pleasantly quiet trains to Paddington, over which the sun was rising.

Maybe I should get up at this time every day, I briefly thought. 'Briefly' because I remember an old mentor and colleague telling me how he always got up at 4am and did two or three hours' writing before he got ready for work. He has written some excellent textbooks as a result, but I'm afraid I just value my life in the land of nod too much to even contemplate it.

Liverpool Street station was easy: the machine spat the ticket out as soon as I put Jo's code in, and the train to Colchester was a bit quaint: old-fashioned bouncing-up-and-down-seats with lots of tables. I wasn't sure about the upholstery - bright blue cushions with a flying pigs motif - but they're not as bad as the most recent Great Western assault on our eyeballs: lurid purple with shocking pink squiggles. Their graphic designer must have been luvved-up on ecstacy at some laser show when he came up with that one. But the guard (as they have started to call them again on SW Trains now, instead of the horribly corporate 'train manager') DID manage to show some sympathetic discretion when I was on a train too early for my ticket. So maybe I was wrong in what I wrote in yesterday morning's post: but I'll keep an eye on it and report it back to you.

Colchester is a new place to me, and an extra hour meant time for a cycle ride round the town centre - quite a graceful place, with some interesting higgeldy-piggeldy streets with names like 'Sir Isaac's Walk'. But if you think Essex is all flat - then think again if you intend to cycle from the station to the High Street: it was a bit strenuous for my ageing cardiorespiratory system - but at least I made it to the top without the indignity of having to get off and push.

Arriving at the Haven is like rolling up to a rather large well-kept and nicely proportioned suburban house in an affluent part of the Home Counties, which I suppose is exactly what it is. But it certainly wasn't like having an appointment to do a formal review of a mental health facility. The first to greet me was Meg, their part-time and slightly arthritic PAT Labrador; next we were introduced to the slightly spooky white cat with beautiful green eyes, that seems to have left home and adopted her new family, as only cats can. Then lots of people, and the business of the day began.

One of the questions I'm asking at every 'Innovation Centre' is what picture they would like put on this blog, that they are proud of. The good people of The Haven had many homely objects to choose from, and some willing human volunteers - but they soon arrived at consensus that it should be their embroidered banner, which hangs in the main living/group room:

As before, if anybody reading this was there for the meetings - please say something below.
It will all be quiet for a few days now, as our next outing isn't until Aylesbury next Tuesday.

CANDI floss

The first thing that slightly flummoxed us about site visit number two was that we were expecting it to be up near 'Camden', or perhaps 'Islington' - as we have always known it as the 'Camden and Islington project'. But when we looked up the postcode, it was slap bang in the middle of Bloomsbury - just off Russell Square, in the midst of London University. We didn't quite believe this, so rang everybody we could think of who had or might have been there - but they were all switched through to voicemail. Who said the era of long lunches is over? So we went off to the address which corresponded to the postcode we had, which in fact it turned out to be right - because we later learned that the borough of Camden and Islington (and the PCT boundaries) went as far south as the northern edge of the council area of the City of Westminster, and Westminster PCT .

As the sun had come out  (or had we come out of the SUN?), we thought a race across London would be quite a good idea to keep us sharp. It was going to be Top Gear-style: Sue on the bus, Lisa on the tube and me on the Brompton bike. Unfortunately, it didn't quite work like that, as Sue and Lisa decided that they'd rather go on the tube together, and by the time I got to the end of Wandsworth Common and looked at the map I decided that it was FAR too far to cycle, on a cold day when I was expected to turn up looking reasonably composed and suitably smart, so it was the Northern Line for me too.

Unfortunately, we made a bit of a boob with this one - we hadn't made it clear enough that we wanted to talk with service users as well as senior staff. So we are going to need to schedule in a second visit, to see the service user gang. But it's probably just as well, because it is quite a complex project - particularly how it has developed and changed since it started - so we had a very useful and detailed discussion to understand just how it all works. We probably would have been half in the dark, if we had tried to fit in everything else we wanted to. So watch out here for the second visitation, which will probably be in March.

But we didn't want to fail in our mission to take the obligatory photo, so we took two. The first is of the lobby, which we thought was rather elegant and uncluttered; the second is of a filing cabinet. How boring could a photo be? Well, if you look above the filing cabinet - you will see what we colloquially know as 'Frankie's Wedding Cake' precisely amended to show the PD services that exist in Camden & Islington (and Bloomsbury).

A civilized entrance lobby

An interesting chart in the office

So that's it for day one. Tomorrow, off to deepest Essex.

Here comes the SUN

OK, Clapham Junction wasn't all that bad, and they're trying to improve it by having jazzy lifts to all the platforms, and it WAS quite easy to find the right train to Balham. And Balham itself was quite interesting - a retro-tube station on the corner, with Californian traffic lights. And rows and rows of decent solid victorian houses on the dawm cycle ride to the hospital, where I was met by somebody I have never seen in my life before - but offered a cup of tea and comfy room to watch the SUN come up (forgive the pun).

The meetings went to plan - firstly in a consulting room in a converted nurses home and then in a converted ancient ward from the days when Springfield used to be the County Asylum for South West London.

Now, as one of the purposes of this magical mystery tour of the country is for 'getting the message out there'. So just what is 'the message', and why use a blog as part of it? The problem is a bit of a Catch-22: we won't know just what the message is until we have been round everywhere, and we won't know how best to use the blog until we have talked to everybody about it.

In our minds, the message is something like 'people around the country, in these different innovation centres, which used to be called PD pilots, have done some extraordinary work in completely new ways, involving all levels of the system, and it needs to be taken seriously'. At least that's the message we're starting out with; we are collecting mountains of data to back it up as we go round, and it might end up quite different.

The medium is quite another aspect. The one definite thing is going to be a rigorous report which will analyse, summarise and communicate everything we gather on our travels, and suitable parts of it will be put through various channels that are available to us at the Department of Health. The rest will 'emerge' as the process develops - and it is the softer, more varied and less concrete. Again, we have started off with some 'ground level' ideas - but will modify them as we go. One rather nice one that came up this afternoon is that we will take a photo at each site, and post it on the blog for each entry. What we have already decided to do with Ann, our web supremo for the national PD website, is to offer each site a web page there for 'official information', and to offer each service user group we meet a page for whatever artistic and creative things that they want to put there (like poems, drawings, paintings, photos, videos, sound clips or pdf documents). If the service already has a good website that they are quite happy with (for example, on their NHS Trust's server), then we will just put a link to it from the national site. If they don't already have an 'official' website, or want to use some pages more flexibly than their organisation's policies allow - we will be happy to host it. Or if they want to stay completely quiet about what they are doing - we'll leave them alone (but we hope not many will choose this option). But if people want to use our national PD website in other ways, we will try to help.

Our very helpful focus group at SW London SUN wanted their photo on the blog - though not everybody in the group wanted to be in it - so here it is.

Can we ask that they do us a small favour: could each of you, when you see your picture here, just add a few words to the 'comments' about what the day was like for you? You don't need to identify yourself in any way if you don't want to. Thanks!

Next - off on the Northern Line to the other side of the river... (People who don't know London might not understand the enormous significance of this!)

Triple Whammy

Triple Whammy

[Image] Dawn over SW11 It's not nice having to get up for the first train of the morning, especially when the next one, an hour later, would only make you five minutes late - but sometimes things are more important than an hour's extra sleep. How Jim Naughtie and Euan Davies do it, and sound so normal as well, is truly impressive.

This morning the first thing to hit my ear drums was their jolly banter about the weather - how it just hasn't stopped raining all night in London, which is just where I'm about to go to, with my folding bike - and having just left my rain cape at the hospital yesterday. Ho hum.

Dawn over SW11

Clapham Junction is arguably the second most alienating railway station in Britain, though it'll need to do a lot of work to catch up with Birminham New Street. Of course, the whole network is trying very hard to do serious alienation at the moment: with their robotic communications, insistence that we're 'customers' rather than 'passengers', and training their previously nice and friendly staff - usually 'railwaymen' and 'railwaywomen' to the core - to fear treating those 'customers' as fellow human beings and ever being able to exercise flexibility or discretion. At least we've got that 'UK Train Times' app that seems to be able to do seriously useful things - like knowing which platforms trains are going from before the station staff do, and taking you home without the need for any intervening thought. Who needs to talk to a human being any more?

It may even be a quadruple whammy, as there is also the 'Sarf London' factor - which makes a train journey to somewhere like Balham, then a cycle ride to Springfields Hospital feel a bit like an expedition to the source of the Nile or the Star Wars space cafe. Just why does North London seem so much more understandable and easier to get to - with tubes going nearly everywhere, and places that you have at least heard of?

It's never too late.

Just where do we start?

We should have been doing this nine years ago, when the government started to realise that there was a pretty big mental health problem out there that most NHS services aren't set up to deal with. An awful lot has happened in the last nine years, and this feels more like the end than the beginning. We're in such austere times, with limits on funding, with it feeling almost impossible to start anything new, and with many aspects of all our lives getting more harsh and severe. The national PD programme, which has done all sorts of things in the last nine years, is going to finish in March 2011 - and this blog, plus the website that goes with it, might be all that's left by April.

However, we're not going to get morose and glum here -  though we won't be putting a shiny corporate gloss on everything either. Most people in the PD movement will be experiencing at least some aspects of the national gloom at the moment, and we don't want to minimise that. Many good things that happened, and positive developments that are still happening. We hope that this blog, and the processes going on behind it, will help to link people up and build on the positive developments. Maybe a long shot - but we're going to try our best!

To get up to speed, let's do a good things/bad things list - about everything that has happened in this field since 'No Longer a Diagnosis of Exclusion' came out at the end of 2002.

Bad things

• Henderson Hospital and Main House closed: no NHS provider now has residential beds for adult non-forensic PD (what we call 'Tier 4 provision').
• The new government-funded pilot services (see below, good things) only cover 9% of the population.
• With so many NHS changes, nobody knows whether they are coming or going - and the general institutional response is harsher management control and less space for grass roots creativity.
• The new training (KUF - Knowledge and Understanding Framework) is very very difficult to get going in this environment, even with the decent funding from the government that it is getting.
• Recession and cuts, cuts, cuts. 
• For service users, considerable fear about being forced into work; for clinicians, a worry that the benefits system will fail to recognise their mental disorder, and so make them more unwell.

Good things 

• Eleven new pilot projects started in 2004 - and all of them are still going strong. The 'final clinical review' of them all will be the main preoccupation of this blog from now until March.
• Many others - number unknowable - have also started since then in the 'mainstream' NHS. We're going to start tracking them down and including them on the national website in April.
• Lots of other pilots and new ideas have also been developed in prisons and secure units (though they are not going to feature in this blog)
• Inspirational and attitude-changing training being set up across the country (KUF - but also see the down-side in 'bad things', above) 
• Useful NICE guidelines (BPD and ASPD) which aren't over-prescriptive, were published in January 2009
• Roadshows throughout the country to disseminate the 'Recognising Complexity' guidance for commissioners (mental health and others) were very well supported.
• Exceptional energy and enthusiasm has come from the PD service user (aka 'experts by experience') movement, represented by organisations such as Emergence (nationally) and STARS (in the Thames Valley). But probably many more around the country that we don't know about yet (So please respond to this blog if you are one of them!)
• A 'First National Congress' at the ICC in Birmingham in November 2009 to celebrate all the innovation and creativity: opened by Lord Victor Adebowale and hosted by the BBC's Mark Easton.

That's enough to start with.
Next posting expected when we're on the round-England journey, starting on Tuesday.
Here's the map of where we're off to:

PDB