Author Archives: mark

So, what kind of monster eats a mental health magazine?

The below is the editorial for the autumn 2013/winter 2014 issue of One in Four.

A resolve and a mystery

Happy New Year! If this is your first issue of One in Four, welcome! We hope that it’s a mix of mental health news, views and information that works for you.

2013 was a year of great hardship for many and certainly change for most. Changes to benefits eligibility rules, rearrangement of NHS services and reductions in funding to a variety of services have left many of us squeezed between coping and not coping.

These system wide changes, many resulting from changes in government policy, has introduced even greater worries into the lives of people with mental health difficulties.  Many struggling to get through things have found themselves struggling even further.

We all need help from time to time.  In 2014, as in every year since we began in 2007, One in Four remains committed to bringing you real life experiences, ideas and knowledge to help you make your way through life and to find the help and support that you need.

What kind of creature eats a mental health magazine?

If this you are one of our regular readers, it won’t have escaped your attention that this is the autumn/winter edition of One in Four.

You might reasonably be asking: where is the autumn edition of One in Four?  Don’t worry, it didn’t get lost in the post.  The answer is that it got eaten.  Not by a dog, like the traditional forgotten homework, but devoured never the less.

So, what kind of creature can eat an issue of a mental health magazine?

As regular readers will know, One in Four is written by people with mental health difficulties, for people with mental health difficulties.  As you’ll also know, One in Four came out of my own experiences of mental health difficulty.  Not an historic experience of mental health difficulty.

Any of you who experience depression will know of the capacity it has to devour time and to make words that once seemed full of meaning and sense turn to ash in your mouth.  Depression removes your nerve, makes the possible consequences of any action seem far too terrible to contemplate.

The autumn issue of One in Four eaten by the editor’s depression.  It would be hypocritical to avoid speaking about my own mental health difficulties in a magazine about mental health difficulties. I generally don’t do so because there are far more interesting things for One in Four to publish than accounts of my own experience.  I have a diagnosis of Bipolar II which means I’m mostly mucked about by depression.  I’m not that interesting.  I’m also lucky.  Our company is set up to understand mental health difficulties and make adaptations for them.

We haven’t got much in the way of resources to produce One in Four, so me, as editor, being out of action held things up.  Like many in far more severe situations, we couldn’t pay for outside help so we had to sit the grey storm out.  With the understanding of colleagues I made it through and the issue you’re reading now is the result.

This isn’t an admission or a confession, it’s a statement of fact.  Mental health difficulties are just that; difficulties.  They sometimes come along and muck things up.

Here’s hoping One in Four can help make getting around those difficulties even a tiny bit easier.

Mark Brown


(don’t worry, all subscriptions are for 4 issues rather than a calendar year. Look out for your autumn/winter issue arriving soon)


Mental health and wellbeing of ‘marginalised’ communities: new Public Health England points way?


A photograph of gregor henderson, director public mental health and wellbeing, Public Health England

Gregor Henderson, director of public health and wellbeing, Public Health England

On Thursday 4th July I was lucky enough to be live-tweeting from the Public Health England (PHE) event ‘Mental Health, Marginal Communities and Wellbeing: The Public Health Challenge’.  You can see a collection of tweets from the day in this storify, which do a pretty decent job of capturing what was said.

The event was an attempt to begin to map what the role of PHE will be in addressing the mental health and wellbeing needs of ‘marginalised communities’.  The day addressed two different dimensions of public health; focusing on specific mental health and wellbeing inequalities experienced by particular groups in communities and on the ways that community resilience might be built.

The day was opened and closed by Gregor Henderson, director of public health and wellbeing for PHE giving an interesting insight into the challenges and opportunities that the idea of ‘public mental health and wellbeing’ presents.

These are early days for PHE.  It only took up its full responsibilities as an executive agency of the Department of Health on 1 April this year, on the same day that responsibility for public health passed to local authorities.

Gregor Henderson, director of public mental health and wellbeing for Public Health England took the opportunity to begin to outline the boundaries, challenges and opportunities for PHE in defining and defining public mental health practice.

Henderson used both in his framing speech and his summing-up of the day to stress a number of challenges for PHE and for the idea of public mental health and wellbeing.  He spoke of the need to find a narrative around public wellbeing that would land effectively with the general public at large. He claimed that the idea of wellbeing as something different from the absence of mental ill-health was in a ‘quiet revolution’; moving from being fluffy to being something that can be measured and which can, and does, influence policy.

Henderson also spoke of PHE as being a kind of interchange for knowledge about both the needs of various communities but also ways in which those needs might be met.  He invited those present on the day – and by extension all working with or affected by issues that influence mental health and wellbeing – to work with PHE, stressing that it’s impossible for a large institutional bodies to see and know what’s happening on the ground for people and communities.

Hovering In the background were the massive implications of beginning to think of mental health and wellbeing not as a an individual matter but one where it is possible to take action upon its social determinants.  The challenge of this shift was not lost on Henderson, who repeatedly described the event, the recent changes in public health responsibilities and the incorporation of public mental health into PHE as ‘the beginning of a journey’.  He claimed that while England might have an arguably effective ‘mental illness service’ we haven’t yet found the right way to build a mental wellness service.

He went to great pains to say that PHE can’t ‘do public mental health and wellbeing’ alone; that it needs everyone with an interest in the wellbeing of communities to “put a bit of skin in the game” and find ways to collaborate and learn from each other.  It is the first time that mental health and wellbeing have been included so specifically in public health commitments, and the first time that the responsibility has been positioned outside of medical services.

’Marginalised’ communities, intersectionality, prejudice

The ‘marginalised’ of the event title referred, in the main, to characteristics protected (unlawful to discriminate upon) under the Equality Act 2010.  The day itself was an extension of previous Equality Forum events, but the first with PHE.  The protected characteristics are;  age; disability, gender reassignment; civil partnership; pregnancy and maternity; race, religion and belief; sex and sexual orientation.

Across the day, speakers addressed the mental wellbeing and mental health needs and life situations of a variety of groups of people.  These included carers, those with drug and alcohol issues, specific groups within otherwise marginalised groups, lesbian, gay and bisexual people, trans people and older people.

Just how complex the idea of public mental health and wellbeing actually is if we begin to consider it seriously sounded loudly from the majority of the presentations across the day.  If we take public mental health and wellbeing as, at a very basic level, the consideration of wider factors and their effect on populations, it becomes clear that the interaction of different factors in the lives of people is a very complex thing.

Interestingly, for those who keep up with the debates that rage across social media, Dr Chris Whiteley, speaking about dual diagnosis and the mental health and wellbeing needs of those using substances (and the substance use issues of those experiencing mental health difficulties), raised the issue of intersectionality.  Intersectionality as an concept tries to understand the ways in which different categories (man, woman, disabled, south asian etc) interact with each other to create specific social inequalities.

Whiteley made the point that people with substance use issues and mental health needs often receive far less help and support than they would if they experienced one of the other of those difficulties.   For him, siloing drug misuse, alcohol abuse and mental health as different health needs rather than interlinked needs to be challenged.  Whiteley’s observation was people’s lives are complex, with people simultaneously belonging to a number of different categories, but that services tend to want ‘simple’ and are often committed to dealing with one particular problem or characteristic.  This theme was echoed across the day by a number of speakers.

The effect of prejudice and discrimination of the mental health and wellbeing was also raised by a number of speakers.  A number claimed that the stress and other situations that result from outright discriminatory practice and the experience of being labelled other or deviant significantly impacts upon the resilience and wellbeing of individuals and communities.  Chris Whiteley suggested in answer to a comment from the floor that discrimination can be a kind of trauma.  This may seem like an obvious point, but it points toward one of the prime challenges of public health approaches to mental health and wellbeing.  To quote Gregor Henderson, one of the purposes of a public health approach to mental health and wellbeing is to ‘find the causes behind the causes’.  In other words, the aim of public health approaches to mental health and wellbeing is to try to influence situations, communities and structures rather than treating the individual for symptoms or situations once developed.

LGB and T

The event very sensibly refused to lump together lesbian, gay and bisexual (LGB) people’s issues with the issues faced by trans people, who in the words of Dr Louis Bailey speaking on trans people’s mental health are ‘often the T that gets knocked off the end of LGBT”.  Dr Mike King spoke about the mental health of gay, lesbian and bisexual people.

Bailey outlined many of the findings of the Scottish Trans Mental Health Study 2012, focusing on the ways in which health services are constructed influences the outcomes for trans people.  88% of trans people told the survey they’d felt depressed, 53% had self harmed and 84% considered suicide.  Trans people often wrestle with being trans for many years before seeking help and support.  The average age of transition (passage from one gender to another) is 43 years.  Trans people often wait long periods to be accepted by gender identity clinics (GICs), with average journey to those GICs being in range of 200- 300 miles there and back.  Trans people are required to live ‘in role’, which means working, volunteering, studying or training in the gender role they are transitioning to for two years before they are offered access to hormones and surgery, something that Bailey said leaves them open to hate crime as this policy increases their visibility as trans while offering no ways to minimise the response of others to their trans status.  There are, Bailey pointed out, a lot of low income and unemployed trans people.

Bailey said that many trans people surveyed felt that medical professionals still had outmoded ideas around gender and behaviour appropriate to gender role and that 27% lied or withheld information from gender professionals and that 33% were concerned about their mental health but didn’t say.  For Bailey the conflation of gender dysphoria and mental health difficulty continues to follow trans people, with trans people often experiencing mental health difficulty but having that used as a way of minimising or ignoring their trans status.   According to Bailey, gender reassignment reduces suicide risk and improves mental health and wellbeing but is still situated in outmoded models of understanding gender and has significant bottlenecks.

Addressing LGB mental health Dr Mike King pointed out that the UK is top of a table of of 43 countries in terms of legal rights for LGBT people, but that this does not always reflect experience ‘on the ground’.  Still, said King, LGBT people are more likely to experience hate crime than straight people but less likely to report it.  King suggested that homophobia and prejudice created situations of stress which have an impact on the mental health and wellbeing of LGBT people.

King spoke of research suggesting that the most homophobic children have the most homophobic parents, and that intervention at primary school age in terms of training and teaching was most effective in changing homophobic and prejudicial attitudes.  He quote a yougov poll that said that 9 out 10 teachers had no training in ways to tackle homophobia within their classrooms, within their staff team and within the families and communities to which their pupils belong.  For King “homophobia, sexism and paternalism travel together”.  He did not downplay how deeply rooted homophobia can be, itemising its wellsprings as disgust, religious ideas, fear of infection and corruption and the defence of masculinity.

King pointed out that there is still institutional prejudice against gay people, despite the UK’s strong legal protections.  As an example of the ingrained nature of attitudes, King pointed toward that the majority of companies that are recognised Stonewall Top Employers awards choose not to make reference to this on their websites or promotional materials.

King reiterated that gay people have a higher prevalence of mental health difficulties.  He quoted a Danish study that showed people were 8 times more likely to kill themselves if in a civil partnership than those who were not, and were twice as likely to die by suicide than a person who was in a traditional marriage.

King saw the idea of public mental health and wellbeing as representing a way in which previously scattershot attempts to challenge prejudice could be drawn together to tackle upstream the attitudes that cause problems.  He also saw it as a chance to begin to understand the needs of LGB people to find ways that services might better address their needs.  He pointed out that, for instance, we know very little about the mental health and wellbeing of older LGB people.

Older people, carers and ‘compound marginalisation’

Someone who did know about the needs of a variety of older people was Helen Ramsbottom of Age UK.  She shared the five key themes that older people had identified for discussion with commissioners: age discrimination, participation, relationships, health and income.  She spoke about the need for “robust, upstream interventions’, actions to help people in the present that would prevent more serious problems in future.  She pointed out that the most sensible times to give help were at points of transition: from work to retirement, after the lose of a loved one, at the point of a serious illness or loss of independence due to disability.  She also stressed that effective interventions were local and specific, rather than generalist and abstracted from lives and communities.

Steve McIntosh of Carers UK gave a presentation that brought together findings around both the impact of caring on carers and also the ways in which carers form a marginalised group themselves.  He termed this ‘compound marginalisation’, leaning on similar ideas to Chris Whitely’s use of intersectionality.  Again, the reality of life as complex did not fit well with services and support based on considering one characteristic.

According to McIntosh,  6.5million people provide unpaid care in UK.  This has risen 600,000 (11%) in last decade.   2million people care for over 20 hours per week.  13 percent of carers care for someone with a mental health difficulty, around 850,000 people.  McIntosh pointed out that this is not without its impact: people who are carers can drop out of work, education, community life, socialising.  61% of carers report having experienced depression as a result of caring, with 87% saying that caring had affected their mental health negatively.

McIntosh said that there was a particular challenge for carers for those who experience mental health difficulties, as there is a stereotype of care as being ‘hands on’.  Unless carers recognise themselves as carers they cannot access any help of support that is available for carers.

McIntosh also stated that the current way in which social care eligibility is structured, in his words ‘High level needs, low level means’ is storing up a crisis for the future as it actively prevents the commissioning of upstream services with a preventative approach.


Across the day, the focus on population or area based public mental health and wellbeing chimed strongly.  To those of us who have been floating around community development or who have involved in the Big Society and its fallout since 2010, the ideas were well established: namely the focus on building the assets and resilience of communities.

Lucy Smith, Public Health Manager – Mental Wellbeing, Lambeth and Southwark, shared a different form of community interaction.  She focused on the the work that the London borough of Lambeth have been doing to build  up the wellbeing of the area.   She reference research that found that social relationships were as beneficial as quitting smoking to a person’s overall health.  For her, the next horizon for public health is focusing on social relationships and interconnectedness, rather than individual lifestyle issues

The borough offered small grants to community groups to carry out projects, building in mental health awareness and wellbeing training.  More on the borough’s health and wellbeing work can be found here.

Jonathan Lamb spoke about work he’d been involved in Longsight, Manchester.  The project targeted specifically Pakistani women and worked by getting to know the community and then finding appropriate ways to influence and support their mental health and wellbeing.   To quote Lamb: “Community mapping allowed us to understand local people’s experiences, build trust and develop a database of local assets and stakeholders. Community Focus Groups established strategic agendas and areas for immediate action. Led by a Community Champion the Community Working Group designed, piloted and distributed 3000 multi-lingual calendars addressing mental health literacy and awareness of services. Launching the campaign on South Asian media, they established a Facebook and twitter group reaching over 20,000 users and are producing multi-lingual relaxation CDs.”  Lamb commented that lack of identification with western medical understandings of mental health was an issue spoken about more in the literature than was actually expressed ‘on the ground’.

In the project the community focus group helped to identify the issues experienced by the target group while the community working group put into action interventions and developed the actual services.  Lamb noted that the traditional mental health promotion model is horizontally targeted, aiming to encourage access for everyone, while the project he had worked upon was targeted very specifically.  He also spoke about the ways in which the introduction of Improving Access to Psychological Therapies (IAPT) actually made it harder for some in the community they were working with to access support as it reduced variety and reduced relationships.  Lamb suggested that part of the value the voluntary and community sector in mental health is as a bridge between communities and NHS and local authority services, helping communities to trust services, or particular people within services.

Many of the speaker spoke about the need to build mental health and wellbeing literacy.  This was strongly confirmed by Poppy Jarman of Mental Health First Aid England (MHFA England), who spoke of their mission to raise the knowledge of mental health amongst individuals and communities as a way of empowering people to take action.  MHFA England was set up as a social enterprise in 2009 to offer ‘first aid’ style training to trainers who then train others in the techniques.  Their aim is to save lives by training people to train others in ways to sustain good mental health and build resilience.

The final speakers of the day brought home the obligations and responsibilities of PHE as a first responder to events in the same way as emergency services.  Richard Amlot and Carla Stanke of Public Health England both addressed the impact of extreme events like terrorist attack or flood on the wellbeing and mental health of communities, and the mechanisms that PHE has been developing to minimise the psychological damage such events cause.   Addressing floods, Stanke spoke specifically about the knock-on effects (primary & secondary stressors) on individuals such as loss of possessions, interruption of communications, lack of access to support and difficulty of securing insurance payments.  Stanke good social connectedness mitigates against the psychological and physical impacts of events like flood, reinforcing the argument made by other speakers for the vital nature of relationships and community.

While these are early days for Public Health England, there is something genuinely exciting in the optimism present in a new body and a new approach.  The intention to get to ‘the causes behind the causes’ will warm the hearts of many long-term activists and campaigners.  Henderson noted that there is a tension between local, community based responses and the wish or intention to provide cohesive, comprehensive services.

Henderson repeatedly stated that the broad narrative is not yet there yet to get the public thinking about mental health and wellbeing not just as an individual lifestyle matter but one where community and policy level changes are as, if not more, important.

The reality of this challenge was acknowledged by Henderson, who pointed out that while there is lots of great stuff happening, to make the change that many would like to happen, there will be some outdated structures, practices and organisations that will have to go.

So, the question would go: If we stop thinking about services as being the solution public health and wellbeing challenges and try to look for solutions further ‘upstream’, what can we do to help people have better mental health and greater wellbeing?

As Gregor Henderson says, for PHE at least, it’s early days.


Mark Brown is the editor of One in Four magazine.  He is @markoneinfour on twitter

Gap between policy and practice for some NHS inpatient services

There is a big gap between the aspirations of the governments strategy for mental health No Health without Mental Health and the reality of its implementation in inpatient settings, according to the The Care Quality Commission (CQC) in their Monitoring the Mental Health Act in 2011/12 report published in January.

The third such annual report, it represents the duty the CQC has to monitor how services in England exercise their powers and discharge their duties in relation to people who are detained in hospital under the Mental Health Act, or subject to community treatment orders (CTOs) or guardianship. While it found that there were excellent example of care, naming particular services and hospitals as examples it also found that there had not been enough forward progress from its previous two reports: “For example, 37% of care plans checked by CQC showed no evidence of patients’ views; there was no evidence that patients had been informed of their legal right to an Independent Mental Health Advocate (IMHA) in 21% of records reviewed; almost half (45%) of patient records reviewed still showed no evidence of consent to treatment discussions before the first administration of medication to a detained patient.”

Commenting in the summary the authors of the report state: “It is with great regret that CQC notes that there are themes that recur year on year and paint a picture of practice in some areas of mental health provision that is a far cry from the policy vision.”

Monitoring the Mental Health Act in 2011/12 can be downloaded from the CQC website:

This news story appears in the Spring edition of ONEinFOUR magazine. Subcriptions cost just £10.00GBP for 4 quarterly issues.

Worries about mental health funding

Former Care Services Minister Paul Burstow, speaking at Public Service Events’ Mental Health: from Strategy to Reality conference on March 14th revealed worries about the level of funding being used for mental health in ENgland. While praising progress made by the Coalition government, he told delegates: “2 in 5 mental health trusts in England admit have staffing levels below Department of Health benchmarks.” Writing for The Telegraph newspaper on the same day he claimed: “The NHS default remains stubbornly biased towards physical health. A terrible false economy at the expense of people’s lives. Depressingly, in 2011/12 spending fell by 1%. Crisis resolution and assertive outreach both saw reduction, and while half the country protected spending, the other half made deep cuts… Dig deeper and you find huge variation from one part of the country to another. Previously unpublished data from the 2011/12 investment survey reveals that spending ranges from £315 per head to just £97.91 per head. The average spend is £166. These are figures reveal yet another postcode lottery.”

Burstow was announcing his appointment as of chair an independent commission by the think tank, Centre Forum. The commission will report next year.

Paul Jenkins of Rethink Mental Illness issued a statement in support of Burstow saying: “These figures highlight how patchy mental health care is across the country. Just 10 per cent of people with severe mental illness are currently being offered talking therapies for example. We have supporters who have sat on NHS waiting lists years for this basic treatment, which should be available to everyone who needs it.”

According to a Care Quality Commission update published on 12th March, in the first nine months of 2012/13, the CQC found that mental health and learning disability services struggled to maintain adequate staffing levels: in 104 inspections 80% services met the standard. This compared with 91% of inspections in the whole of 2011/12.

This news story appears in the Spring edition of ONEinFOUR magazine. Subcriptions cast just £10.00GBP for 4 quarterly issues.

NHS changes not April fools joke

One in Four editor Mark Brown summarises the NHS changes coming up on April 1st that may have passed you by

April the 1st is the date of one of the largest reorganisations of the National Health Service in England since its birth in 1948. Most of the changes are concerned with who makes decisions about health and social care and who services are provided by. These changes will not have a huge immediate impact on day-to-day services but are significant long-term changes to how the NHS works

Clinical Commissioning Groups (CCGs) formally replace Primary Care Trusts (PCTs) as the bodies which commission care. They have the power to buy services from any provider that meets agree standards, not just from within the NHS. Clinical Commissioning Groups include GP practices and other health professionals. While all GP practices have to be members of a CCG, the level of power individual GPs have will differs from area to area. While CCGs may have been initially envisaged as smaller and more local than PCTs, the 211 CCGs cover areas of similar size and population to the now defunct PCTs.

Local Authorities (councils) now have responsibility for public health, meaning they will control budgets for taking actions to improve the health of the whole community they serve . The government expects them to work more closely with other health and care providers, community groups and agencies, using knowledge of local communities to tackle challenges such as smoking,alcohol and drug misuse and obesity.

Sitting between CCGs and Local Authorities are Health and Wellbeing Boards, made up of health and social care decision makers and elected members of the public. A kind of steering group, Health and Wellbeing Boards feed into decision-making such as the Joint Strategic Needs Assessment process that works out what an area must to do to address the needs of those who live there. They are also expected to lead on reducing health inequalities (differences in health between different groups or areas). The Health and Wellbeing Board will, in theory, be where the views of members of the public will influence decisions.

Also on April 1st the process of switching patient and public engagement organisations from Local Involvement Networks (LINks) to Local Health Watch will be completed. LINks, first created by the Labour government in 2008, were independent bodies hosted by voluntary organisation intended to hold health and social care service to account and to feed in local views to decision makers. Each local HealthWatch has a similar remit. In some areas the organisation that had run LINks were successful in bidding to become a local HealthWatch while in others Local Healthwatch will be run by a new organisation.

While maintaining its leadership role, The Department of Health will from April 1st no longer directly manage NHS organisations. Some of this function have been passed to the NHS Commissioning Board, which will oversee CCGs and will agree their funding. This, in theory, shifts decision making outside of government for the NHS, although the Secretary of State for Health, currently Jeremy Hunt, retains the ultimate responsibility for the overall system. The organisation, Monitor, has the role of regulating all of the new structures of the NHS. They will also from 2014 be the body that approves and provided licenses to bodies both NHS and none-NHS that provide services to NHS patients. Along with the NHS Commisisoning Board, Monitor will also be responsible for setting the pricing of NHS services to work out the cost of patient care from 2014/15.

The reorganisation is the result of the changes to the ways in which health and social care is to be delivered brought into effect by The Health and Social Care Act 2012. The Act had a long passage into law under the leadership of the previous Health Secretary Andrew Lansley, and the changes that it has created still divide opinion. While Social Care is included in name in these reforms; a Care and Support Bill which will clarify future structures is currently at draft stage.

Four case studies of young people’s mental health projects

If you’re interested in young people and mental health, here’s your weekend reading sorted….

As some of you may know, One in Four editor Mark Brown has been working on a number of case studies of young people’s mental health and wellbeing projects for Right Here, the five-year, £6m initiative young people’s mental health and wellbeing project jointly managed by the Paul Hamlyn Foundation and the Mental Health Foundation running from 2009 to 2014.

Each of these four case studies is a summary of a mental health and wellbeing project commissioned and/or run by young people.

The four case studies are:

What if young people tried to change the way GPs treat them?

Young volunteers with the Right Here Brighton and Hove project decided that good research and persuasive presentation were better than just complaining. A case study of the activities of Right Here Brighton and Hove.

Boxing clever?

An unusual mental health and wellbeing project in east London is using boxing to help young people get sorted. A case study of a project using boxing to reach vulnerable BME young people in Newham, commissioned by Right Here Newham

Who looks out for young mothers?

Case study of a year long young mother’s group in Enniskillen run by Right Here Fermanagh, a partnerhship to improve the wellbeing of young people led by Youth Action Northern Ireland as part of their work around mental health early intervention with 16-25 year olds.

A not so trivial pursuit

Young people create mental health boardgame, hire professional designers to design it. A case study of some of the activities of Right Here Sheffield


There’s also a couple of bonus pieces, one about young people’s experiences of violence violence called, erm, ‘Young people and violence’ which is based on the findings of Right Here Newham about the lives of young people in Newham, Inner London and a summary of the Right Here project’s showcase event ‘A Voice and A Choice’.

Happy reading!

A Voice and A Choice – Right Here young people and mental health showcase 4th February

The three panelists at Right Here showcase 4th February 2013

Our panelists. Photo: @AshleyGlos

Yesterday, I was lucky enough to be live tweeting from ‘A Voice and a Choice: Right Here Showcase‘ a day long event taking place at London’s Wellcome Collection.

Right Here is a joint project between The Paul Hamlyn Foundation and The Mental Health Foundation. They describe themselves as a national initiative “creating responsive services that provide young people with the mental health support and advice they want, when and where they want it.”

Right Here is now in the 4th year of a 5-year programme. Their aim is to develop new approaches to supporting the mental health and wellbeing of young people in the UK aged 16 to 25 focusing on intervening early to help young people at risk of developing mental health problems and to tackling the stigma associated with mental health that often prevents young people seeking help. To do this they have funded local partnerships to work with young people to commission services that they think will help other young people. This has been to four regional partnerships across the UK; Right Here Newham in London, Right Here Sheffield, Right Here Brighton and Hove and Right Here Fermanagh. Each of the partnerships have carried out very different activities and are made up of very different organisations. Over the last eighteen months Right Here has also branched out into exploring digital applications created through co-production with young people.

‘A Voice and a Choice’ was an event that showcased what the individual Right Here partnerships have been doing alongside a number of workshops and seminars from other youth-related organisations. Attendees were asked to vote on which of five themes – Big Asks- developed by Right Here young people should be taken forward as most important for future work. Right Here also shared the exciting news of just where their explorations into digital frontier in young people’s mental health and wellbeing are taking them next.

There’s a storify of all of the tweets from the day here and there’ll be a more detailed official event report (written by me, too) later this month. Today, I’m just going to report on some the things that I saw and heard.

Young people: Lots of ‘em

The first thing of note about ‘A Voice and A Choice’ was that there were young people really fired up about mental health at ‘A Voice and A Choice’. Lots of young people fired up about mental health. I had the pleasure of hanging out with a number of them over the day as they tweeted, discussed and presented across the day.

If you’ve been to conferences about ‘young people’s issues’ before, you might expect involvement of young people  to have been limited to a few slots saying how brilliant it was to have services provided for them.

At ‘A Voice and a Choice’ it was obvious how much the young people involved are partners, not subjects to be empowered. Over the day I heard young people outlining the problems of mental health services, explaining and showing what it was like to be a young person accessing a service, explaining what it was like to live in a constant climate of fear and violence, and -most excitingly – not just outlining the problems they’d identified but, how as part of Right Here, how they’d come up with solutions and put them into action.

Right Here as a national programme puts a strong emphasis on young people being the drivers of projects. Each regional partnership has a youth panel that is involved in all aspects of decision-making. Many of the individual projects carried out in each area are co-develoepd and co-delivered by young people for other young people.

The feeling that came across from ‘A Voice and A Choice’ was not of young people saying ‘listen to our demands’ but ‘work with us to support and amplify these changes that we’re in the process of making happen ourselves’.

Some Threatening figures

To provide context and to answer the question of why we need more good projects for young people’s mental health and wellbeing Rosemary Watt-Wyness, Director of Policy and Strategy at Prince’s Trust, shared the headline results from their annual Youth Index, which tracks young people’s confidence and happiness.

According to Rosemary, 22% of the 2136 young people aged 16-25 they surveyed don’t feel they have anyone to talk to about their problems, 31% of young people ‘always’ or ‘often’ feel down or depressed and almost one in five young people feel that they have ‘no future’ because of the recession.

The statistics and the economic and social realities show that life as a young person in the UK is getting more difficult and the threats to individual wellbeing more pronounced.

Things tended to be worse if young people were not in education, employment or training. Make no mistake, these are challenging times for young people as a whole, but what of young people with mental health needs?

One of the most interesting panel discussions I’ve heard in ages

Part of the introductory session for the day was a fantastic panel discussion: one young person from Right Here interviewing two other young people from Right Here. Far from the usual dessicated discussion with sector talking heads outlining why we need to change how we do things while simultaneously explaining the reasons why we can’t change things, the young people talked about their own experiences of services and what pragmatic and practical steps could be taken to make them better.

What came through strongly was a sense of NHS services for mental health being uniquely difficult to access, even if you’ve managed to get the information about what to do to access them in the first place. One of the interviewees spoke about the fact that he only learned that he could ask for a double appointment at his GP to discuss his health concerns through Right Here Brighton and Hove’s project to give young people more idea of what they can actually expect from their GP. Before that there wasn’t any way he would have known that, regardless of how useful it would have been to him.

The interviewee also spoke about the fact that NHS services, which may see themselves as series of gateways to treatment and support, often act unwittingly as a series of barriers instead. Having been told he would receive a phonecall about an appointment for a mental health service at 9.00AM he had been so worried about sleeping through the phone ringing due to sleep disturbances related to his condition that he’d stayed up all night. The phonecall never came. He received two identical letters later telling him that he’d missed the opportunity for an appointment and would have to wait. He said that it was only through him hounding the services in question that he’d actually been able to access any help and support. He pointed out the brilliant bind that if you work office hours and mental health services work office hours, how will either of you manage to talk on the phone to arrange something?

His message was that traditionally structured services do not fit the lives of young people. Outlining how Right Here developed and commissioned projects, he explained that the Right here project he’s involved in made sure that they tried to match the structure, timing and location of activities and services to the people they were hoping to come to them.

His co-interviewee echoed his experiences and thoughts and wondered whether flexibility was even possible with more traditional services – how do you expect to help people having a difficult time if you make it as difficult as possible for them to get help?

The Big Asks

One of the things two things that Right Here were debuting at ‘A Voice and Choice’ was their ‘Five Big Asks’. These were five statements or demands were a kind of fighting manifesto for how young people involved in Right Here’s projects would like to see the world change. Delegates were asked to vote on which on they thought most important.


The Five Big Asks were:

We want young people services which:

1. Reunite body and mind (ie treat the mental with the physical because we don’t think they are different)

2. Connect with us, don’t correct us (ie engage and involve us, rather than talk down to us and pathologise us)

3. Are youth-loving, not youth-leaving (we like the services and they like us and they don’t exclude us) and don’t dump us at age 18! (ie stop planning and commissioning children’s and adult’s services in separate boxes, stop making young people do the transitioning, and make the lifecourse approach a reality)

4. Make us the best that we can be:  don’t settle for just feeling less bad – reclaim the “health” in mental and stop using it as a synonym for “illness”

5. Come to where we are (ie services are delivered in places in their communities where young people, especially the most vulnerable, feel most comfortable)

The winning Ask by a long chalk was no.3; calling for services not just to dump young people at 18, calling for commissioning of services that joined up seamlessly and which didn’t let people fall into the cracks. As one of the interviewees on the panel discussion asked: ‘Just what support is there for you if you’re a young person who leaves school at 16? Where are you meant to go? How are you meant to even get information about where to go?’

Digital Innovation: A new frontier

The second thing launched at ‘A Voice and A Choice’ was the first public announcement of the organisations that will be talking forward seven different digital projects for young people’s mental health and wellbeing that grew out of Right Here’s activities.

Across a year from December 2011 young people, tech professionals, mental health and youth work folks and others worked together through a series of innovation labs whereto come up with ideas for ways apps and websites might make young people’s lives better and easier. These final ideas were whittled down to eight briefs which were then put out for people to bid to develop them with funds provided by Paul Hamlyn, Comic Relief and Nominet Trust.

I’m hugely excited by this, not least because I’m involved in developing one of them! The list of apps being funded are as diverse as the organisations developing them:

• Mind’s Eye: An online mood monitoring and wellbeing tool to maintain good mental health that reflects and links moods to young people’s everyday lives. It will be developed by Mindapples and Unboxed Consulting

• Madlyinlove: A website dedicated to young people’s relationships and mental health issues, offering support and information to young people with mental health problems and their partners. It will be created by YouthNet

• Doc Ready: A digital tool that will support young people to ensure that when they visit their GP they use their consultation time effectively. Enabled By Design, Neontribe, Futuregov and Social Spider (that’s me!) will develop it

• Medfacts: A straightforward and reliable online information and advice service on how prescribed drugs may influence mental and physical health. YoungMinds and Tictoc will develop it

• Keep the trust: An online support, advice and informal training service that can be used to support adult non-health professionals, who have been identified by young people as influential or important people in their lives. This will be built by sixteen25 and Cernis

• My Places: An online tool that maps local services and helps young people to identify reliable and trustworthy support networks, with the ability to rate services and leave feedback. SussexCentral YMCA, VividBrighton, Right Here Brighton and Hove and Mind Brighton and Hove will create it

• MiniMe: An interactive recovery guide that uses personal information provided by the user on their activity, environment and mood, with the ability to issue an alert to friends and family when in need of support: FACT (Foundation for Arts and Creative Technology), RedNinja and Mersey Care NHS Trust will create it.

They’ll all be launching by July 2014 and all will be developed with the involvement of young people, many of whom will be involved with Right Here. Neither Right Here nor the funders have done anything quite like funding of digital apps, so it represents an exciting new frontier.

Practicalities, visions and nuts-and-bolts

One of the most interesting aspects of the day, for me at least, was that across the workshops and presentations there wasn’t really a split between the people advocating for change and innovation and the people concerned with the nuts-and-bolts of actually making things happen. It’s often the case that the evangelists and visionaries get in, make an exciting, yet oddly insubstantial speech, then get out quick, leaving the people concerned with practicalities grumbling and muttering in their wake.

Across all of the workshops there was a lot of thinking about what needed to be solved and what need to be done to make solving it possible. One very strong idea that came up repeatedly was that young people feel alienated, worried, confused and sometimes oppressed by being forced into using big, unfamiliar and ineffable services. The very simple and pragmatic suggestion was to get mental health professionals out of their clinics and units and into community spaces where young people are comfortable.

I was fascinated by the young people of Right Here Newham talking about the realities of being black or minority ethnic and growing up in an inner city area. I’ve blogged a bit about that elsewhere

Another very strong theme that came up repeatedly was that relationships are as important as services for young people. Who you get to know through getting help or sorting yourself out can be as important as what the service or activity you’re accessing actually does. Being able to feel part of something and part of a group is a valuable corrective to the ways in which accessing mental health support is effectively solitary and isolating.

I think there was a reason that the advocates for change and the pragmatists didn’t do their traditional trick of separating out like the oil and water they sometimes appear to be. Both pragmatists and visionary reformers were brought together by the people at the conference that embodied both qualities: the young people of the Right Here projects themselves.

Far from being either passive agents having ‘good’ done to them or wild-eyed optimists un schooled in the way of the world; the young people I met and heard from at ‘A Voice and a Choice’ were young people who’d experienced difficulties, found something that’d helped and seen just enough things of how things can change to know ‘not good enough’ isn’t something for which they, or us, should settle.

Mark Brown is the editor of ONE in FOUR magazine.  He is @markoneinfour on twitter.

Mental health – Celebrities, challenging stigma and the ‘then what?’ moment

Mark Brown has been wondering about where the ‘battle against mental health stigma is now’ and where it might be going next

iA photograph of Stephen Fry, who I am not as funny as

A photo of someone I'm not as funny as

We talk about stigma a lot when talking about mental health difficulty, or at least some of us do.  A stigma is, strictly speaking, a physical mark of disgrace.  It’s something inflicted on a person’s body by a society that is understood by that society both as a punishment and a warning.  The thing is, mental health difficulty is something that happens in your head.

Erving Goffman described stigma as “The phenomenon whereby an individual with an attribute is deeply discredited by his/her society is rejected as a result of the attribute. Stigma is a process by which the reaction of others spoils normal identity.”

So what is it we’re stigmatising? What is it we’re spoiling? I think there’s two possible things we’re stigmatising: the behaviour of an individual and the way in which their condition affects their life. In having a mental health difficulty there is the direct consequence of what you experience and then, following from that, there is the effect this has on you, your life and the lives of those around you.

Anti stigma: Inspiration or corrective?

At present we’re at the beginning of a concerted effort to attempt to reduce stigmatising behaviour towards people with mental health difficulties.  National multi-year campaign Time to Change is both creating the impetus of this wave and riding it by funding grassroots anti-stigma activities, promoting positive media images and trying to drive up ‘social contact between people with mental health difficulties and people who do not.

Anti-stigma work in mental health, including Time to Change, has recently focused much on inspirational stories and role models or positive examples of people with mental health difficulties doing things.  The logic is that bad implications of mental health difficulty can be refuted by providing a positive image in opposition.  Early attempts at this kind of action tended to rather clumsy: ‘You think people with mental health difficulties are lazy? This man built the world’s largest shed!’

It’s often hard to tell whether an individual story is meant to be inspirational to people who already experience mental health difficulties or to mainly act as an answer to an existing stereotype about people with mental health difficulties.  Sometimes it feels that campaigns try to kill two birds with one stone, such as in the recruitment or publicity of celebrities who experience mental health difficulty.

It’s easy to fall back upon the inspirational story as the main way in which to tackle poor attitudes towards people with mental health difficulties.  The problem with the inspirational story, or indeed the celebrity story, is that it individualises mental health difficulty and, while seeming to appeal for greater acceptance, can inadvertently compound the idea that mental health difficulties are individual failings which may be overcome with a combination of vim, vigour and good humour.

The thing is, sometimes having a mental health difficulty is awful. Or embarrassing.  Or disruptive. Or can make you unemployable. Or turns your house into a mess. Or any of the other unpleasant things having an impairment to your mood, behaviour, thoughts, perceptions or motivations might cause if you don’t have some sort of aid to offset it.

Obscuring real needs

I’ve been wondering whether it’s possible that we are managing to obscure the real implications of having a mental health difficulty by focusing on ‘accepting the person’ while, as some would claim, erasing the circumstances under which they live?  And, as a result of that, are we failing to focus on what might reduce the impact a mental health difficulty has on the lives of people by being unable to see what adaptations and modifications might be made to situations?  In other other words, are we focusing too much on the idea that individuals are ‘judged’ by society and not enough on what it actually is that’s being judged?

The criticism of the foregrounding of celebrities in mental health acceptance campaigns is that the celebrities do not, in most ways, reflect what people are being asked to accept of other people with mental health difficulties.  Some people with mental health difficulties frame this defensively, seeing the celebrity with mental health difficulties as a failed inspirational figure who is targeted at them.  This might be termed ‘You’re not as funny as Stephen Fry’ syndrome.  This view goes as follows: the celebrity is being held up as an example of ways in which people with mental health difficulties can overcome their impairments and be successful.  The celebrity, though, has access to more advantages and material aids than an average person with mental health difficulties, therefore is a misleading guide to what ‘the public’ may expect from people with mental health difficulties in their lives.

If we step away from the personalising and relating to own circumstances in that argument, we are left with the core idea that what people are being asked to accept about mental health difficulties is that people have them, but aren’t being asked so much to consider what the implications of those difficulties and impairments actually are.

The reason why the use of celebrities with mental health difficulties by campaigns gets on people’s nerves is because people feel that their use involves asking the public to accept what they have already accepted.  They already know and like the celebrity, they are fairly aware of the various aspects of their story.  They accept that they have a degree of legitimacy as a person; they have, after all, succeeded enough to be famous.  This obscures the fact that for people with mental health difficulties to find a real advancement in our circumstances, we are not only asking for ‘the public’ to accept that people have mental health difficulties, but to also accept the effects having a mental health has upon people’s lives.

Accepting a person, ignoring a situation?

Mental health difficulty is a series of impairments.  These impairments have real implications for what any individual needs to live a viable and fulfilling life.  At present we are, to my mind, extremely bad at addressing that impairments cause needs which in turn cause outcomes when those needs are not addressed.

We know that having a mental health difficulty tends to make a series of social outcomes more likely for us.  We also know that different mental health difficulties tend to make different messes of your life.

I like to think that we are merely at the ‘coming in from the cold’ stage of mental health awareness; the initial stage of raising the idea that people with mental health difficulties are discriminated against and stigmatised.  On that basis, I think we need to see current campaigns and understandings as a transitional stage on the way to a better settlements for people with mental health difficulties.

But where are they a transitional stage on the way to?

At the moment, the idea of challenging stigma and the idea of making things better for people with mental health difficulties are viewed as synonymous, but I’d be very worried if this linkage were to continue indefinitely.   The danger is that we split into two mental health worlds, one involved in attitude change work and one that tangles with and knows how mental health difficulties play out ‘on the ground’.

For me, what’s holding us all back is being unable to stake out the ground for an exploration of what impairments mental health conditions cause and what we can do to assist and mitigate against those impairments.  I think this is the natural next stage after our current period of foregrounding the anti-stigma struggle – the shift from saying ‘accept people with mental health difficulties exist’ to ‘accept that we need to make changes to the way things are so that people with mental health difficulties are no longer excluded’.

I draw no comfort from ‘accept that it’s an impairment having a mental health difficulty’.  I have one.  I know that.  I’m more excited by the question of ‘how do we reduce how much the impairments presented by mental health difficulties actually disable someone?’

Can we get from saying ‘be nicer to people with mental health difficulties’ to reducing the mess that having a mental health difficulty makes of your life?

Then what?


Mark Brown is the Editor of One in Four magazine.  He is @markoneinfour on twitter

How will you remember 2012?

An image of a snowy mountain top forming the cover of Winter One in Four magazineBelow is the editorial from this Winter’s One in Four magazine summing up 2012

As we go to press Chancellor George Osbourne has just announced in his Autumn Statement on December 5th that austerity will continue in the UK for at least another 5 years. Cuts to services, economic slowdown, worries about rents, jobs and changes to benefits, all collide to make for a somewhat shaky sense of security. Many of us will look back on 2012 as a difficult year.

The issue of mental health found itself in an interesting place in 2012. In a broad sense, 2012 has been the year when mental health went mainstream, or at least certain aspects of it. As mental health tweeter @sectioned_ notes on page 20, mental health is finding its place within the wider issue of disability as a niche political issue. As we see in our coverage of the Mind Media Awards on page 19, mental health is also breaking out of its dull-but-worthy ‘issue’ box and finding its way into mainstream, prime-time programming. The Commons debate in June where MPs discussed their own mental health difficulties was a significant event, as we noted at the time, as have been the increasing number of celebrities ‘revealing’ their struggles with their own mental health. Channel 4′s ’4 Goes Mad’ season stoked a short-lived flurry of discussion around mental health. The NHS mandate (see News) also can be seen as a major step forward, with the government specifically asking the NHS to give mental health the same esteem as physical health and to bring things like waiting times and choice in mental health in line with experiences in physical health. On one level, 2012 has been a year of progress. The issue of mental health has managed to get into the high-flying world of Westminster politics and air-kissing media. People have been talking about mental health, but have they been talking about the right things?

Out on the ground, the feeling of 2012 has been slightly different. Many people with mental health difficulties feel under threat from cuts in services, shrinking budgets, changes to benefits and a hardening attitude towards social security and the Welfare State (see News). With the economy failing to pick up and local and national government making tough decisions and even tougher noises, many with mental health difficulties have been on the receiving end of a huge dose of destabilising change. As we see from Fabio Zucchelli’s experience of moving from working for the NHS to using the NHS (see page 8 ) progress isn’t a uniform business. There are still many areas in the experiences of people with mental health difficulties that aren’t moving forwards as quickly as we’d like. The consequences of austerity and economic depression have fallen heavily on people with mental health difficulties, many of us who were low on resilience and reserves even before the current challenging times began.

Changing law and fighting for the things that people need to have a good, safe and fulfilling life is vital, but it’s not something you can do all of the time. We can’t stay angry and afraid from the time we get up to the time we go to bed. Sometimes we need to have fun. For some of us the Olympics and Royal Wedding presented a welcome respite from worry.

Our lives are a constant interplay between big events that touch the lives of millions and the tiny things that just affect us, our communities, our families and friends. It’s important to remember that as much as it’s important to take on the big fights and big issues; it’s also important to nurture the things in our own backyard, too. Fun and pleasure isn’t an optional extra, nor is companionship, love and fellow-feeling.

If there is one thing that became clear in 2012 it’s the fact that people with mental health difficulties need each other, and our allies, more than ever.

Here’s to 2013.

Mark Brown, Editor

This editorial appears in the Winter edition of One in Four magazine, out January 2nd. Mark Brown is @markoneinfour on twitter

Of sock puppets and service user groups

An image of a sock puppet This week the Department for Communities and Local Government (DCLG) launched a document 50 ways to save: Examples of sensible savings in local government a compendium of ideas for cutting the amount of money that councils spend. Some are sensible, others are more contested.

One that caught the eye of Karl Wilding, Head of Policy for the National Council for Voluntary Organisations (NCVO) was recommendation number 37. It’s worth looking recommendation number 37 in more depth because it may have implications for mental healths service user groups, or at the least smears their name a little. It suggests:

Cease funding ‘sock puppets’ and ‘fake charities’: Many pressure groups – which do not deliver services or help the vulnerable – are now funded by state bodies. In turn, these nominally ‘independent’ groups lobby and call for more state regulation and more state funding.61 A 2009 survey found that £37 million a year was spent on taxpayer-funded lobbying and political campaigning across the public sector. Many of these causes may be worthy, but why should they be funded by taxpayers?”

The term sock puppet is a confusing one if you’re not a veteran of internet message boards. In that context a sock puppet is an account set up by someone under another name to contribute to discussions in such a way as to support the points made by that person under their primary account. You can spot sock puppets in online discussions quite easily; they will usually only comment where a particular person comments and then only to agree with that person or to attack someone who disgrees with them.

So what relevance has this to the funding of mental health service user groups by local authorities?

This is interesting for us in mental health because, up until this point many mental health service user groups have drawn at least some funding from local authorities and have often seen it as their role to hold to account and to lobby for the interests of people with mental health difficulties. Would these count as sock puppets?

In support of the idea of “’sock puppets’ and ‘fake charities’” the document cites a discussion paper by Christopher Snowdon produced by the Institute for Economic Affairs Sock Puppets: How the government lobbies itself and why

The executive summary of the discussion paper suggests says government spending on civil society (or the third sector if you’re keeping it pre-2010) grew massively during the period that Labour held office between 1997 and 2010 and thatt this erosion of autonomy is bad for society as charities stop representing people and begin to act as a ‘shadow state’ of things funded by the state but which aren’t part of it.

This is an argument that many have made from different positions in the political spectrum. But that’s not about sock puppets. Sock puppets are mouth pieces of political interests, the paper has it, and

This paper argues that there is a deeper problem if government funds and/or creates pressure groups with the intention of creating a ‘sock puppet’ version of civil society which creates the illusion of grassroots support for new legislation. These state-funded activists engage in direct lobbying (of politicians) and indirect lobbying (of the public) using taxpayers’ money, thereby blurring the distinction between public and private action.”

So, for Snowdon (and the DCLG it seems) ‘sock puppet’ charities are charities that campaign on certain issues and which call for greater government action over particular issues. The discussion paper says:

State-funded charities and NGOs usually campaign for causes which do not enjoy widespread support amongst the general public (e.g. foreign aid, temperance, identity politics). They typically lobby for bigger government, higher taxes, greater regulation and the creation of new agencies to oversee and enforce new laws. In many cases, they call for increased funding for themselves and their associated departments. In public choice terms, they are ‘concentrated interests’ compelling the taxpayer to meet the costs that come from their policies being implemented, as well as the costs of the lobbying itself.”

Karl Wilding wasn’t happy with this. He told Third Sector:

“”The sock puppets report is terrible: it’s badly researched and it vastly overstates its case. We know that most funding from government for voluntary organisations is for the delivery of services, not for advocacy and certainly not for lobbying government.

“I think it’s particularly disappointing to see this recommendation at a time of year when many local authorities are thinking about their budgets for next year and therefore thinking about their relationships with the voluntary sector.”

Nestled as it is within 49 other suggestions to local authorities for saving money, it’s easy to overlook what the implication of recommendation 37. If the DCLG means sock puppet in the same sense that Christopher Snowdon and the Institute for Economic Affairs means sock puppet; it is suggesting that councils should feel free to stop funding groups that represent minority interests and ones that either do, or don’t lobby for change in particular areas.

Fair enough, you might say, why should local authorities fund people to disagree with them or waste money funding people to agree with them; especially if they are taking forward issues that are not of interest to the majority of people?

But where does this leave locality based mental health organisations? Small locality based mental health organisations, including service user organisations, have seen their role as collective advocacy primarily, with delivery of services second. The argument for why your local council should fund a small mental health campaigning / service user group /collective advocacy has often been that other sources of funds are not easy to come by and that if the council thinks mental health is important, they should stump up some cash.

Some would argue that mental health groups and organisations that are trying to change conditions, systems and services should not be funded by any state money for reasons of independence and political autonomy (Snowdon’s lead-off point is just that). This recommendation from DCLG seems to suggest that local authorities should not, on principle fund something like a local mental health forum or service user group because they are either a)paying someone to agree with them or b)paying someone to disagree with them.

Traditionally, mental health advocacy groups have campaigned for greater allotment of funds to mental health and greater provision across a number of areas covered by local authorities. Now, with the rejigging of responsibilities begun by the passing of the Health and Social Act local authorities are increasing involved with health as well as social care. There is much commitment to user voice in these ideas, but it seems the DCLG has set a trap for organisations that support service user voice by introducing a way of discounting as ‘sock puppetry’ or the need to avoid appearing to create it any request for money that they may make to continue their role raising awareness and pushing for better or different services.

As with much of the stuff that floats out from central government in terms of ‘helpful guidance’ under any government, the chances are these 50 recommendations will only speak to the people who already agree with them, so will have limited direct effect. Politically, though, the 50 ways to save are part of a struggle about what responsibilities governments, and by extension taxpayers, have to pay for certain things.

It seems that DCLG is suggesting that local mental health organisations, those keepers of the flame of a minority interest (the interests of people with mental health difficulties) might be getting an even colder shoulder from their local council than they did before.

It seems like socks for Christmas is just as much of a crap present as it always has been.

Mark Brown is the Editor of One in Four magazine.  He is @markoneinfour on twitter