If you thought Brexit was a mess.....

A British journalist is being interviewed by the police for 'misgendering' the child of a high profile transgender activist (update: the case also involves tweets labelling the treatment given to the child - not presently offered legally in the UK - as 'mutilation' and 'child abuse.'). The activist, Susie Green, runs Mermaids, a charity which supports young people who think they may be experiencing gender dysphoria, and also runs national campaigns and advocacy programmes. Mermaids recently received a £500k grant from the National Lottery which is now under review. Meanwhile the Tavistock Centre, the one specialist youth gender clinic in the UK, was subject to a critical report earlier this year, and questions have been raised about the quality of care for young people who are prescribed puberty blockers.

This is a deeply personal and potentially very distressing area. Research suggests that a significant percentage - possibly a majority - of teenagers who consider themselves to be born in the wrong body, no longer hold that view in adulthood. That still leaves a significant percentage for whom it is a settled reality that persists into adult life. At what stage is medical intervention wise, or justified? If adulthood may not fully kick in until you're 30, how long should people wait, or be made to wait? (Susie Green flew her child out to Thailand at age 16 for medical procedures not available in the UK, and for which Thailand has since raised the minimum age to 18). Are the other issues experienced by children with gender dysphoria related to it, or are they exacerbated by the isolation, bullying etc. which can go with being 'different'?

Unfortunately, like Brexit, this debate has taken on all the appearances of two pit bull terriers fighting over a rabbit. With a rapid rise in the number of referrals for childhood/adolescent gender dysphoria, and increased public profile (and debate - see the current issue in athletics over what categories trans athletes can compete in, or what prayers vicars are allowed to say with people who have transitioned), this is something which needs careful, evidence-based, serious discussion, not flame wars on social media and the police being called in on people who disagree with you.

Fewer of us are in, or grew up in, stable family relationships than previous generations. There is a higher level of sexual confusion, mental distress, and risky sexual behaviour than we have seen for generations. It's no longer possible to advocate a 'normal' or 'ideal' vision of sexuality, relationships and human thriving without being labelled as psychologically unbalanced (or 'phobic' to use the shorthand). Everything goes, and tolerance is the prime virtue. At one level, the flux gives us a chance to discuss previously taboo areas, at another the level of confusion makes it highly possible that we will botch things. Where mental, physical and spiritual wellbeing are at stake, we  - and especially those wrestling with questions about their gender identity - are not served by hysteria, prejudice and trench warfare, on either side of the discussion.

update: major piece in the Times about the Tavistock clinic (paywalled)

Sex Education from the BBC: what's missing?

More than a third of women and a quarter of men in their teens and early 20s admitted it had not been "the right time" when they first had sex.  Thus the BBC reports on the 'National Survey of Sexual Attitudes and Lifestyles'. They then give a helpful list for anyone wondering...

When is the right time?

• If you think you might have sex, ask yourself:
• Does it feel right?
• Do I love my partner?
• Does he/she love me just as much?
• Have we talked about using condoms to prevent STIs and HIV, and was the talk OK?
• Have we got contraception organised to protect against pregnancy?
• Do I feel able to say "no" at any point if I change my mind, and will we both be OK with that

Yup, 'Am I married to my partner'? doesn't come into it. The first 3 conditions are subjective - the survey assumes that children as young as 13 are able to answer these questions well and be 'sexually competent' Have they ever met a 13 year old? All the criteria would be also satisfied by someone cheating on their partner.  The only moral question here is consent - tick that box and everything else is ok. Is sex really that trivial? 

I note in passing that the report never refers to 'children' - "22.4% and 36.2% of men and women who had first sex at age 13–14 years were categorised as ‘sexually competent". Child sexual behaviour is reported as if it were adult sexual behaviour. Am I alone in finding that a bit disturbing?

The genuinely radical option here is to honour sex as the ultimate physical expression of commitment, saved for the one person to whom you make the lifelong covenant pledge of marriage. Even if you don't buy the 'sex as an expression of commitment' thing and just want to be pragmatic about it, if you value the relationship you're in, you'll wait, as it's better for the relationship.  

There are public health benefits too: sexually transmitted diseases are transmitted by, you guessed it... They jumped massively in 2012-15, and the number of people attending sexual health clinics in Wales has doubled in just 5 years. There would be dramatic falls in STIs if it was normal to pursue faithfulness to a single partner and public health policy encouraged people to wait. Sure, not everyone will do it: not everyone takes up the MMR vaccine either but that doesn't make it bad practice. And it could save the NHS up to £1bn a year, which is before we get into all the other financial costs of a culture of casual sex.  A culture which the BBC itself has been normalising for decades. 

One of the complaints in the Br***t debate is that you can't question immigration without being labelled as racist. Can we discuss sexual behaviour without being labelled as moralising? 

First Peek at Christmas TV Schedules

You saw it here first....

Luther: in an updated version of the 500 year old tale, a disgruntled millenial pins 95 Christmas present requests on his Facebook profile, and causes a Europe-wide revolution when he doesn't get what he wants. Originally billed to star David Cameron but nobody's seen him for months.

Doctor Where? Live coverage of an A&E department on Boxing Day. There's a New Year special too, where the Doctor scours the globe from India, to the Philippines, to most of Africa, trying to find treatment for her sick companions, only to discover that all the trained health workers have left to work for the NHS.

Mrs Browns Buoys. Panorama special following the irascible crew of a border crossing in the middle of the Irish Sea. May run until late 2020. Or longer, much longer.

Les Miserables. The new name for BBC regional news

Waterstones Shop Down. Amazons besiege the last remaining high street shop, in a rural town somewhere in the Midlands. A host of celebrity cast members realise that ghostwritten biographies are are too insubstantial to defend themselves against the incessant volley of attack, most of it aimed at the address next door but they called and nobody was in. Where in the shop is there a book substantial enough to save them?

The Mash Report. Stocktake at the local food bank. Starring roughly 160,000 households.

The Queens Christmas Massage. By special dispensation, delivered this year by Tyson Fury. To Donald Trump.

Match of the Day: Special Edition. Which footballer can match their salary to how much they are actually worth?

I'm a Celebrity Get Me Out of Here! No.

Childrens Mental Health treatment: Free, but 55,000 miles to the point of delivery.

You might find the following account hard to believe in the UK in 2016, but it's the real ordeal of a local family, whose teenage daughter developed mental health problems after bullying. They live in Yeovil, but just look at the places where their child ended up for 'care'....

"We've had to section her on seven occasions, the first being in September 2013 - that was at Sevenoaks in Kent, she was there for about eight weeks."

Since her first admission, she has spent periods in mental health hospitals in Southampton, Manchester, Woking, Norwich and finally Orpington in Kent.

She has had to be treated hundreds of miles away from her home because there are no inpatient beds available in Somerset.

Her parents have visited her virtually every weekend as she was battling her illness, spending £25,000 and racking up 55,000 miles of travel just to see her.

"She would get put in different hospitals - from Southampton she was moved to Manchester for a weekend, and then spent four months in Woking. Many of these mental health hospitals are privately owned, they're profit-making organisations. Often it appears they never have enough staff."

Her mother said that it was "heartbreaking" to be separated from their daughter by such huge distances. She said: "I feel as though I've missed out on two and a half years of our daughter growing up. You get a phone-call at night and she's crying her eyes out and you're like 250 miles away and you know there's nothing you can do to help her."

"We've spent £25,000 over the last three years just to see our daughter - that's food, accommodation, petrol, taking her out to places, everything. A lot of other people can't afford to do that. We were told that either the NHS or the county council would reimburse transport costs, but we've heard nothing from either. There's no continuity of care. We've never been back to the same hospital; it's always a different psychiatrist or a different doctor, and it's soul-destroying."

This is scandalous. It's enough of an ordeal to have an ill child, but how on earth is all of that supposed to help the child recover? 

This is not a one-off, it's happening repeatedly to adults as well as children, and school heads are now flagging up mental illness as a major concern. 

The health check we never get

Prevention is better than cure, at least that what my mother said. This doesn't apply to all aspects of the NHS. We are given cardiac checks, bone density checks, regular dental checks, all sorts of fiendish tubes are inserted into our bodies, and yet, at no time do we have a regular mental health check. As our brains control the functions of our body, would it be sensible to look after the brain first?

It's only when we are experiencing mental illness do we get noticed, and then it's luck of the draw if we actually get speedy and efficient help. Different areas offer varying services. Some are excellent, some are definitely not!

Mental illness can develop slowly or very quickly. At least an annual check up would help. If this was routine, then the stigma of mental illness would soon disappear, and just like popping to the nurse for a blood pressure check, it would be simply part of our lives.

by guest blogger Miriam

"Having HIV doesn't mean I can't have the quality of life that Jesus offers'

Very very gutsy thing to do:



Rev Hayley Young's courageous (that word again) explanation to her church about her HIV diagnosis following an attack. Good piece here on the BBC, including the struggle of being someone who's supposed to have 'the answers'. "There are times when God feels far away, but ultimately that peace and that strength are there".

Libdem Manifesto: Green Monster with Medicinal Purposes

The smaller the party, the bigger the manifesto. Labour, the Conservative, Green and UKIP all clock in at around 80 pages, but Nick Cleggs little monster, channeling a 70s wallpaper designer, is 158. The pages are a bit smaller, and a couple of them are taken up with an index (bravo!). As with Labour, and the Conservatives, here are a few things which stood out.

1. There is some genuinely radical stuff in here, which the Libdems have either been a bit coy about, or the mainstream media aren't interested in because they'd rather have arguments about maths. That's a shame, because the radical stuff is potentially the most significant.

2. At the same time, spot the consensus: more free childcare, more nhs funding, 0/7% on overseas aid, control immigration, devolve power both to the countries of the UK and to local governments and cities, reduce tax on the low paid, build more houses. All 3 main Westminster parties are saying the same thing in these areas. They all use the word 'plan' on their first page as well. Snore....

3. It may be that the other parties have put their detail elsewhere, or just left it out of public gaze entirely, but there is a lot of detailed thinking and policy here. This document has the only fully-fledged strategy on climate change and the environment, nearly a fully-fledged strategy on mental health (see below), and a lot more finesse in several areas than Labour or the Conservatives. Before you think I'm getting carried away, there are several things I'm completely opposed to....

4. Greenery: there are more nods from Labour towards this than the Tories, but the Libdems tackle climate change and the environment head on. It's one of their 5 'front page' priorities, along with education, balancing the budget, fair taxes and the nhs, and there are '5 Green Laws' which cover a whole raft of stuff, from conservation areas, to zero emission cars to renewable energy. 60% of energy from renewables by 2030, zero carbon economy by 2050 with zero carbon traffic, 70% recycling rate by 2020 and (I liked this) a commission to look at what resources we're using in an unsustainable way, with power to push us to cut consumption. At the same time there's the only proposals I've seen to build houses resilient to rising temperatures, and a lot more incentives towards insulation, energy efficiency etc. And every time a child is born, a tree will be planted. Not many of these will be popular, or cheap, or give a short-term gain, but the Libdems seem to be the only party who are thinking beyond the 8th of May in these areas. Well done.

5. The other one I really like, and you'd expect me to say this, is their policies on mental health - more money, better standards of care, clear waiting time targets. There's a target of getting 25% of of those suffering mental illness into appropriate counselling treatment - that seems a very low target, but perhaps its symptomatic of how poor the support currently is. Imagine of only 25% of people with a broken leg got a plaster cast.... But, for a party which has clearly done a lot of thinking, there wasn't enough on prevention. Yes there's a plan for a '5 a day' type public health campaign on mental health, more on reducing stigma etc. But a lot of mental illness is rooted in what happens when you're young: family breakdown, poor parenting, poor relationships with main carers. As with Labour, and the Tories, this seemed to be a no-go area. Nobody has the courage, or the ideas, to tackle the epidemic of fatherlessness and family breakdown, or to use the network of health visitors and new mums support to give input on parenting and relationships, as well as caring for the new baby. The Libdems are streets ahead of the rest on mental health, but there are still some streets that are no-go areas, and until we walk them, we'll always have a massive problem on our hands. To be fair, the Libdems say more than the Conservatives about promoting and expanding the Troubled Families programme, and want mediation for all separating couples, but wouldn't it be better to build stronger relationships to start with?

6. Cunning plans: everyone is offering more free childcare, the Libdems is are a bit more tailored - 20 hours per week from age 2, but if you're a working parent then it's available from 9 months in, which is when a lot of new mums go back to work part-time after having a child. Discount bus travel for students aged 16-21 is good, to get them into the habit, out of cars, and support the bus network. Getting landlords to insulate houses to an approved standard, putting RE back into the core curriculum alongside some key life skills like finance management.  Oh yes, and giving local authorities more power to cut down on betting shops and the use of addictive betting terminals in their communities.

7. A few contentious ones: minimum unit pricing on alcohol (which has been suggested for a while but nobody has done it), legalising cannabis for medicinal use, and a looser drugs law put under the Health department rather than the Home Office. Decriminalising having drugs for personal use would raise a storm of protest at other times, but there hasn't been a peep about it (yet). Perhaps the Daily Mail is too busy looking for celebrities in badly-fitting bikinis.

8. Being liberals, there's quite a bit on civil liberties, control over what data people can hold about you, freedom to be rude about people and to swim where you like, more support and promotion of equality for people with disabilities, ethnic minorities, and gay, bisexual and transgender people. The cuts to legal aid are going to be reviewed,  and different forms of punishment trialled (badoom-tish) for crime. 'A large prison population is a sign of failure to rehabilitate, not a sign of success'. So they want more tagging, curfews, weekend prison etc., and if you go to prison there's a skills and education assesment in your first week. After the confiscation of books by the Tories, this is a welcome change of direction.

9. Fair play to Clegg, he hasn't given up on proportional representation, there it is again, alongside an elected Lords, more devolution, caps on donations to parties, and a formal process for working out who is in the leaders debates (tick).

10. One which elevated my eyebrows: 'liberalise rules about the location, timing and content of wedding ceremonies'. I guess it depends how liberal, but the gay marriage reforms raised question marks over whether the government even knew how to define marriage, and this takes it a step further. At what point does marriage stop being marriage, and start being something else? There's a difference between pledging 'all that I have I share with you...till death us do part' and singing each other something by Robbie Williams.

11. Housing - again, plenty of detail and evidence of a lot of thinking. Right to Buy is there, but left up to local authorities not enforced by central government. But again, it's frustrating that a party which has done so much work misses some obvious issues. One is housing density - new estates are crammed, with every home overlooked, miniature gardens, and short on facilities. Many new homes have more space for the plasma telly than for a meal table. Joined up thinking on mental health and wellbeing would ask for a maximum housing density and a minimum standard on social space within a home. The Libdems mention loneliness as a problem - well at least give people the space to invite friends round then!

12. There's some thinking on faith, discrimination etc., mostly around supporting interfaith work, protecting Jews and Muslims from hate crime, but also putting RE back in a more central role at schools and giving freedom for 'religious doctrines' to be explained.

13. British Sign Language will be recognised as an official language of the UK. Excellent. Now offer it at GCSE. Outside London and premiership football, most of us are more likely to come across a deaf person than a Frenchman.

And great news for anyone from the SW who likes the Brecon Beacons - once the debts on the Severn Bridge are paid off, the tolls will be scrapped.

Overall, I was quite impressed. Much more than either of the other two parties, the policies seem to be designed with people in mind, and the stress on the environment and mental health is the kind of long-term thinking we need from our politicians, but rarely get. There are some sensible policy reviews (e.g. the constitutional convention on devolution, rather than Camerons divisive populism, legal aid),  and more of a sense that this is rooted in vision and values, rather than managerialism and presentation. It's the nearest thing to what the bishops were asking for a few weeks ago, and is mercifully free of the snide political bashing you find throughout the other manifestoes. I wonder if somewhere in a backroom there are Labour and Conservative strategists going 'why didn't we think of that?'

Because of course, that's the context. Clegg is pitching to 2 sets of people. One is us, the voter. The other is the two other main parties. The Libdems main shot at power is to be a more attractive coalition partner than either the SNP or UKIP. To do that he needs as many votes and MPs as possible, and as many policies as possible which the other parties think they can work with. Given all that's in the manifestoes, a coalition with Labour looks much the better fit: the Conservatives will spend 2 years taken up with an EU referendum and take their eye off the ball, and Labour is offering much less in terms of policy anyway, so there are plenty of gaps for the Libdems to fill. Libdems and Labour are both ok with borrowing to invest, and the Conservatives are riddled with people who simply don't get climate change and green energy, from Owen Paterson to Eric Pickles.

However, I still think that doing all this is a massive challenge if 300,000 new people are arriving in the UK every year; all the money and effort that goes into the nhs, housing and education will only enable us to stand still. Meanwhile there aren't any big ideas, from anyone, on how we integrate communities at a local level. Nobody is producing an evidence-based immigration policy (why do people come here, how many will stop coming if we do x or y) based on a sustainable level of immigration, and leaving the EU is a blunt instrument with too much collateral damage. So we still need UKIP to keep this debate on the table, but probably not UKIPs solution.

AND IT DOESN'T MENTION HARD WORKING FAMILIES ONCE! YIPPEEE! If you're as intermittently lazy as I am, at last, a party you can vote for.....

Conservative Manifesto: The Longest Coalition Document in History?

Hot on the heels of Labour, David Cameron published the Conservative manifesto yesterday. What was most immediately striking, apart from proposals to create social housing ghettoes (see below), was how much overlap the headline policies had with someone else:

 - no tax on people earning the minimum wage (UKIP)
 - raise bottom tax threshold to £12.5k (libdems)
 - extra £8bn on the nhs (Libdems, except it isn't, Clegg is promising £8bn per year, the Conservatives promise 'a minimum of £8bn over the next 5 years', which isn't the same thing)
 - freeze rail fares (Labour)
 - 30 hours free childcare for 3 and 4 year olds (Labour, though they only offer 25)
 - build more houses (everyone)
 - Right to Buy (Mrs Thatcher)

With the exception of the SNP, there are bones thrown in all directions, which either highlights political consensus, or flags up the scope for coalition discussions, depending on how you look at it.

Compared to Labour, it was a much easier document to work through, with some pretty detailed policy sections, and what looked like a comprehensive programme in a lot of areas. Here's what stood out for me:

1. Of the £30bn needed to reduce the deficit - it's 'fiscal consolidation', not cuts folks - £25bn is coming from public services, roughly half from welfare and half from other departments. There's no detail of where most of the welfare cuts will come from, apart from a reduced cap on total welfare income and scrapping Job seekers allowance for under-21s. There'll be a temporary Youth Allowance instead which stops if you don't take one of the 3m apprenticeships or a job.

2. There's a lot of specific regional and infrastructure spending, which makes me wonder why we couldn't have done some of it in the last 5 years. This is a bit of a dividing line with Labour, who despite talking about using borrowing to invest more, don't have the same commitments on infrastructure investment. Curious. However, it does allow them to name drop pretty much every region in the UK, which is politically clever.

3. A lot of devolution - more powers for all the bits of the UK, and for anywhere that chooses to have an elected mayor (and not if you don't!).

4. Tony Blairs Labour had a reputation as the champions of reannouncement, repeating declarations of new spending on several different occasions as though it wasn't the same cash over and over again. The Conservatives go one better, repeating the same announcement within the same paragraph. The pledge not to tax the minimum wage is basically the same as the pledge to raise the income tax threshold to £12,500 per year. At the moment, if you work on the minimum wage for 30 hours a week you earn £10, 452. And the threshold is 10.6k. How convenient! The Tories pledge to get the minimum wage up to £8 an hour, which will earn you £20 per year shy of the £12.5k threshold. So effectively it's the same policy, but announced in two different ways.

5. The married couples allowance stays, and rises marginally, and this is what qualifies as supporting relationships. There's passing mention of the 'troubled families' programme, but no indication of whether it will be renewed, expanded or scaled back. No mention of epidemic rates of relationship breakdown, fatherless families, and the effect all this has on the mental and emotional health of the adults and children involved. There is almost a conspiracy of silence around the family and how to support and invest in it.

6. On education, it looks like things will get a bit quieter - more of the same, rather than revolution. Worryingly for students, there is no mention of the level of the tuition fee cap, so it's left open for this to be increased. Watch this space. There'll also be loans for postgraduate degrees. The education budget is 'protected' - which means that if the number of pupils rises, so will the amount of money. It's not protected against inflation. So there will be a real terms cut in money going into schools under the Conservatives if inflation ever rises above 0%. So the word 'protected' actually means 'cut'. Again and again I was frustrated at the slippery way things were presented in this document, which then made it harder to give credit where it was due. Interesting that they keep the two flagship Libdem policies, free school meals for infants and the pupil premium.

7. The NHS - I really struggled to get my head round how politicians think about this. There's no point recruiting extra doctors and nurses if they're leaving as quickly as they arrive. 5000 nurses are leaving the NHS each year, mid-career. But responding to that entails accepting there's a problem, and like every other section, the bit on the NHS starts with a section on how poorly Labour did and how well the Conservatives have done. Sorry, but there needs to be more reality here. The section on mental health, apart from supporting mums during and after pregnancy (good) had very little. No specific targets, money, or policies. Not good enough.

8. The Big Society is back! All quiet for 3 years, whilst most of us got on with staffing food banks, there's now the new initiative to encourage volunteering (you'll need those extra 3 days a year if you're a governor of an academy, it's a couple of leagues up from being governor of a normal school, and that was demanding enough). I wonder what the Italian paymaster of Westlands, whose workers here in Yeovil will all be entitled to 3 days a year off, will think of that! It's an odd policy, but I think I like it. What I didn't like was the manifesto taking credit for £8bn a year going into heritage art and sport. It claimed this was 'public and lottery funding', but since the lottery puts in £1.6bn a year, that doesn't leave much for the government! In fact, it gets a tax from the lottery, so it makes a profit. Better controls on online pornography are welcome, but I'd have liked to see something on gambling and payday loans.

9. Not many people have picked up on the plan to cut the number of MPs to 600 and revise parliamentary boundaries. That could be quite significant in the long run.

10. Sorry but the Right To Buy plans are like the AV referendum (remember that?) a potentially ok plan scuppered by dreadful delivery. The AV option put to the vote was probably the worst form of proportional representation, and there are a lot of things wrong with the RtB format. Forcing the most expensive properties to be sold off? Well lets have a think. They'll either be the biggest ones (which Housing Associations have previously pulled down to build more, smaller units), or those in the nicest neighbourhoods. Smaller dwellings, and poorer neighbourhoods, will remain social housing. The long term effect is obvious: nicer areas will become almost 100% owner-occupied, and social housing will become more concentrated in areas of lower value. Around here, house prices in Sherborne were recently shown to be £100k higher on average than those in Yeovil. So if you applied the policy locally, all the social housing tenants would end up in Yeovil.

There's also an inevitable time-lag. It takes 10-20 years round here to find and buy land, get planning permission, and build new houses. Without being able to take out big loans, the housing associations won't have the money to buy land and build houses until the RtB units are sold, you can't replace them like tins on a shelf. So RtB will build in an extra shortage on top of the 1.4m that currently exists, around the time it takes to build the replacement properties.

11. Goodbye wind turbines. Subsidies for onshore wind will be scrapped, and they will 'change the law so that local people have the final say on windfarm applications'. Giving local people 'the final say' is a nimbys charter, nobody is campaigning for wind farms to be built on their skyline. What will Eric Pickles do with his time now that he hasn't got all those wind farms to veto? Words about 'cost effective' green technology suggest that economics, rather than carbon emissions, will be the deciding factor for any Tory greenery.

12. I'm worried about propsals to ban 'extremists' from working with children. We all know they mean ISIS sympathisers and the like,  but the way the cultural wind is blowing, anyone like me who takes the 'traditional' line on marriage is seen as a phobe and an extremist. Will there be unintended consequences?

13. The manifesto alludes to 'space for resentment to fester' over Scottish MPs voting on English laws. As I recall, this wasn't that much of an issue until Cameron stoked it up after the referendum last year. Standard marketing practice, create a demand ex nihilo then produce a product that meets the manufactured need. Shabby.

14. I was glad to see the case being made for keeping overseas aid at 0.7% of GDP, with some stats on lives saved, children immunised, access to clean water etc. This needs to keep being said. Well done.

There is a lot more to get your teeth into here than the Labour manifesto, but aside from the economy and infrastructure, where there seems to be a fair bit of thinking, other areas of policy get a token nod. There's nowhere near enough on climate change, family support, and mental health. The loud silences in some areas (food banks, details of welfare cuts) the slippery presentation in others (tax on minimum wage, EVEL, school and NHS funding) and the awful ideas around Right to Buy, don't inspire me with confidence. There's a programme of action, but true to Cameron there isn't much of an underlying philosophy.

Despite the levels of detail in some areas, it just doesn't leave me with a sense of a party which has really got to grips with all the issues we face. It's not just about the economy. The Bishops call for an 'attractive vision' of a society has fallen on deaf ears. The most eye-catching policies are of the 'retail politics' variety - vote for us and we'll give you this. There isn't much here, aside from the aid target and the volunteering scheme, that calls on us to put others first, to think of 'us' rather than 'I'.

Labour Manifesto - Working Hard for The Kingdom of Ed

I wonder if its ever struck politicians that if 'hard working families' are as hard working as they're cracked up to be, most won't have the time or the energy to read an 86 page manifesto, even if a lot of it is pictures. They/we are too busy working hard, getting on, doing the right thing, or whatever it is the Stakhanovs do most of the time.

Maybe Labour knew they wouldn't get beyond page 1, so they stuck this on the cover:

Britain only succeeds when working people succeed. this is a plan to reward hard work, share prosperity and build a better Britain

Odd that they pitch the manifesto to a minority of the British population, given that over half of us aren't working, being too young, too old, too ill, or too busy volunteering (of which more later)

It's a clear pitch to be the Labour party, the party of working people, but with a lot less socialism and toff-bashing than in the good old days. There's a brief swipe at the Conservatives, and no mention of the LibDems (keeping the door open for the coalition negotiations which are bound to begin on 8th May).

There's plenty of commentary elsewhere, but a few things really stuck out to me:

1. There are pledges to increase the number of GPs, nurses and midwives. Unless there's a big change to GP training in the pipeline, it takes longer than a single parliament to train a new GP. So, where do they come from? Will Labour be trying to get health professionals who have quit the NHS to return, or (as under Blair) will they be recruiting overseas? There is a massive moral question mark over this, we have one of the best health services in the world, most other countries need their doctors and nurses more than we do. The Labour manifesto makes much of the UK re-engaging with the world, promoting the Millenium Development Goals (good) but if we poach doctors from developing countries then white man speak with forked tongue. 

2. Kids, wave goodbye to your parents. You'll see them again in 18 years. Labour wants an education system that starts with 25 hours free childcare at age 3 (provided by your renewed Sure Start centre), extends to 50 hours by the time you are 4 (yes, 50 hours. schools will have to provide access to 'wraparound' childcare from 8am - 6pm), and continues until you are 21. Out of work benefits won't begin until you turn 21, prior to that it's a Youth Allowance dependent on whether you're in training. Some of this will be welcome news to parents who need more flexibility so that they can work to bring in the pennies, some of this will simply mean families spending less time together. It's bizarre that in a document which declares Labour believes a decent society grows out of family life and relationships the main policy direction is one which will mean families seeing less of each other. Does Ed Miliband not get on with the rest of his family? 

3. The wraparound school clubs are all going to be provided by volunteers. Really? How? It's a nice aspiration, but there's no suggestion of how it could be achieved. Worse, if it is achieved, where do those volunteers come from? There's no national strategy for encouraging volunteering, so they will have to come from the existing volunteer pool. That's the folk who look after the elderly, run playgroups, staff foodbanks, pop in on neighbours etc. Good luck on either score. We can't even find the handful of adults needed locally to keep a single council youth club up and running for one evening a week.

4. Also on family policy, there are warm words about 'strengthing the institutions that help individuals, families and communities to thrive' but nothing about strengthening families themselves. Sure Start will be resurrected, but mainly as a national childcare agency. 'Early years intervention' is fine, but there's no suggestion of tackling the reasons why this might be needed. Family breakdown remains the elephant in the room, responsible for vast levels of misery, mental illness, educational failure, substance abuse etc. Labour wants a constitutional convention to look at how the UK can hold together, but when did it (or any other party) ever give serious thought about how to hold families together?  

5. One oddity: Labour want to abolish Police and Crime Commissioners, but set up an equivalent version in education, a local Director of School Standards who monitors performance, intervenes in underperforming schools and can commission new schools. Local authorities will continue to be players in the school system, so I'm not quite sure where that leaves LEAs. The roles of PCC and DSS are slightly different, but it seemed odd to be scrapping one and inventing the other!

6. 200k new houses a year won't go very far if 300k people are being added to the population each year. There are no targets for sensible immigration, just a few policies around benefits and controls. This is a real problem. Yes we need immigrants, but there is surely an optimum rate at which people can be assimilated, and infrastructure be put in place? We are adding a new county's worth of people every 3 years to the UK, but short of a specific cap, I haven't yet seen a policy that amounts to more than hoping the problem will go away if we look tough. That hasn't worked yet.

7. Foreign policy: Labour propose a 'global envoy for religious freedom'. Good. Gordon Browns next job perhaps? It would be good to see a specific role though: they also propose an envoy for LGBT rights whose goal will be to secure the decriminalisation of homosexuality worldwide. I'd be thrilled if the goal for the religious freedom envoy was to secure the decriminalisation of conversion to Christianity.

8. Labour seem to be taking climate change more seriously - there's a welcome goal of a zero-carbon electricity supply by 2030, and interest free loans for energy improvements will reboot the domestic solar energy market. Right noises, but I don't see enough on, for example, public transport (most of the policies are devolved to local level) to see a thorough response. There's a welcome commitment to keep the 0.7% aid target and refocus it on the poorest countries.

9. Mental health: will be 'given the same priority as physical health'. I wonder what that means in practice? The document says there'll be the same right to psychological therapies as to drugs. If true, that means free, lifelong access, rather than 8 weeks after a 5 month wait, as is the current (approximate) situation. Do they really mean that? Access to drugs doesn't stop after a set number of weeks, so if that's what's really being promised for talking therapies, then that's a very hefty commitment. And please, not just CBT, it doesn't fix everything. And if you do offer CBT, please lets have proper professional counsellors, not a nurse who's done a short course. Labour wants more access to counselling at schools (good) and there's a suggestion of putting mindfulness on the national curriculum. There's no extra money committed here, only a promise that a higher % of the mental health budget will be spent on children. That, of course, means a lower percentage on adults, so without a significant rise in the overall budget, there's the prospect of a cut to adult mental health funding. Surely not?

Overall Labour are trying not to frighten the horses, but I'm not sure whether the horses will be very inspired either. I guess a proper rationale for the policies (e.g. the 50 hour school week), or proper details of how they'll work (adult mental health) would have needed a longer document. Labour seem more aware of the vulnerable - disabled, users of food banks, low wages - than the current government, but I don't see much of a great vision here. It's a bit more of an engineers budget, how do we make this system work better, and produce more of what we want (houses, good healthcare, clean energy at affordable prices). I can't see it setting many pulses racing, and as the first page states, its a 'plan...for a better Britain'. The P-word again. The 2015 election is the Battle of the Plans.

New Mental Health Resource for Churches

Going live today is the new Mental Health Access Pack, a resource website for churches on mental health and illness, which looks very good and I hope gets widely used. 

Main sections are:
 - common conditions
 - caring for people
 - practical tips
 - what the Bible says

with a range of pages under each one - e.g. mental health and learning difficulties, types of counselling, pastoral policy. There are sections that are worth printing out in full and discussing with church leadership, small groups etc. to a) develop best practice and b) get the church talking about mental health, so that people know it's ok to do so

"Churches have a responsibility to welcome everyone who comes to them in Christ’s name, but the reality is that they don’t always know how best to support people who are struggling with mental health issues. The Mental Health Access Pack will help equip churches to make God’s love more visible in the welcome they offer to every person." (Justin Welby)

As well as addressing our day to day practices, I hope the church makes a concerted effort to get mental health onto the election agenda, as the Libdems are trying to do. 

PS bear with me, I've tried to add a new 'Mental Health Links' to the sidebar and things have all gone a bit pear-shaped. 

How to live 10 years longer

"living a pure life, no alcohol, no tobacco, going to bed early, praising God for his goodness and for the blessing of life".

and

Every Friday evening (the community of) Loma Linda falls quiet. On Saturday, Adventists take the day off from anything that could be considered work.

This includes browsing social media or, in some cases, watching television. For most, Saturday is a day to recuperate from the past week and to be with family and friends.

"Our Sabbath is more than just the church that takes place in the morning," says Dustin Aho, executive pastor at the huge University Church, which dominates the centre of town.

"The actual Sabbath day is in our name, Seventh-day Adventists, and so the day is crucial. What is more crucial to us is the time set aside for our community and for our God."

and vegetarianism. Here's the full story

Mental health - what's changed in 10 years?

I ask… What has any government really done to improve mental health care?
Charities and some very well known people are very vocal about conditions and campaigning for better services and provisions. But what of those that are asking for our vote? Having been in the system for close to 10 years, I have seen many changes…

• Loss of beds on inpatient wards
• Less support services in the community
• Services tailored more to addiction than mental health
• Massive increase in those suffering milder forms of mental illness, that have gone on to develop significant problems, due to lack of attention from relevant medical professionals
• Children being sent hundreds of miles from their families, just to receive the care required
• Mental health crimes increasing
• Police being used as ‘baby sitters’ for those that are deemed too ill to be in society at that time.
• Anti depressants being handed out more freely, with no follow up counselling or support

I have not seen any real significant increase in companies changing their view on employing those with mental health problems. Nor have I seen any huge Government plans to ease or aid the situation. However, I have seen a change in our communities....

read the rest here. Good, honest and challenging post from a local blogger and community organiser in Yeovil.

Close the borders

With todays news that net migration to the UK has risen to over 1/4m, here are a few things that need to go back where they came from.

Black Friday: US capitalist tradition of monetising a popular festival (see Christmas, Hallowe'en), being imported en masse by the UK high street. Except in this case, we don't even get the festival. No  Thanksgiving, just more shopping. Because clearly we don't shop enough. At it certainly doesn't look like it's bringing out the best in our national character. (Update: the following day is now officially called What On Earth Did I Buy That For? Saturday)

NHS Staff: sure, we can't do without them, and we've failed so badly at training our own that we need to import about 30% of frontline staff for hospitals. But are we seriously suggesting that the UK has more need of these trained staff than, say, Pakistan, the Phillipines, Romania? We no longer have the Empire but we're still just as rapacious when it comes to stripping other countries of their assets, in this case, highly skilled medical staff. 25% of doctors from sub-Saharan Africa are working in the West. Meanwhile our own specialists are busy administering botox. Who cares if a few more kids die in Uganda so long as we keep those celebrity wrinkles at bay?

Female 'pop star's: take your pick - Madonna, Kylie, Katie Perry, Britney Spears, Lady Gaga, Rihanna, Beyonce, Miley Cyrus etc. Is this what a feminist looks like? Judge a woman not on the contents of her character but on the absence of her clothing.

Weather: stupid rain, coming over here all the way from Mexico and the US, without a visa, raining on our hills, running down drains built with British money, causing floods that the British taxpayer has to clear up. And there's been more this year than ever before, we're being literally swamped with the stuff.

Flash the 'Tache, Raise some Cash

What with all this excitement, I kind of lost track of things myself, but we are now 4 days into Movember, the mens health awareness campaign. I've already violated rule 1, but with the resurgence of the beard for some of us it will be Shavember before it becomes Movember. The charity prioritises prostate and testicular cancer and mens mental health.

If you're already caused out, what with world mental health day, Children in Need, Remembrance Day, making up a Shoebox for operation Christmas child etc., then just give a friendly nod to anyone who turns up at work this month looking like a dropout from the Village People.

Diabetic dilemma?

I'm opposed to use of embryonic tissue/unborn babies (pick the description which expresses your ethical position) in scientific research. To put it simply I believe that every life is precious and that people are not means to an end.

However I also have a child with type 1 diabetes and was really pleased to hear the recent announcement of a major step forward in diabetes treatment. In diabetes, the immune system attacks the cells in the body which produce insulin, which in turn regulates blood sugar. Being able to create, and implant, replacement cells is the only possibility of a cure, short of a transplanted pancreas. Scientists have managed to create new cells which a) work in mice and b) in large enough quantities to promise a general cure, rather than a few lucky individuals.

There's still a long way to go, but it gives me hope that my child won't have to inject themselves 4 times a day and take their blood sugar on a regular basis.

But, part of the story of the research is the use of embryonic stem cells, i.e. cells harvested from partially-developed unborn humans.

So I have mixed feelings. And mixed thoughts. If I boycotted everything that had an ethically dodgy history to it, I'd have to leave the UK for a start, it being a country enriched through slavery, exploitation of the poor and of other countries. But I do boycott some things, and actively try to make decisions based on my faith and ethics, rather than on what's cheaper/most convenient/etc. How far does that go? I wouldn't dream of denying my child a treatment that could dramatically change her life. It would be easier if it was me that was the diabetic, then I'm the only victim/beneficiary of whatever moral sum has to be calculated.

And if use of embryonic tissue isn't a bridge too far, then what is? If a medical/scientific discovery is made, do we do the best we can with it, no matter how the breakthrough came (e.g. through creating & dropping a nuclear bomb, during an arms race, vivisection, sending a rocket into space rather than helping millions in poverty)? A discovery can't be un-discovered.

As you can tell, I'm a little confused.....

Nick Cleggs mental health target: a remarkable moment in politics

Update: there is currently a 'synchroblog' by dozens of Christian bloggers on mental health. A full list of links can be found here (scroll to the bottom) and here. 

This may or may not be a watershed. For the first time ever, the main announcement in the conference speech of a major UK political leader will be about mental health. Just before his 5 years in government ends, Nick Clegg wants to see a maximum waiting time of 18 weeks for counselling/'talking therapies', and a 14 day target for younger patients.

Here's the relevant section of the speech, in total the section on mental health made up over 10% of Cleggs address this afternoon, and I can't recall hearing anything like it ever before from a party leader

Labour introduced waiting times in physical health – we will do the same for the many people struggling with conditions that you often can’t see, that we often don’t talk about, but which are just as serious. So if you are waiting for talking therapies to help with your depression, you will be seen within six weeks – 18 weeks at an absolute maximum – just as if you are waiting for an operation on your hip.

If you are a young person experiencing psychosis for the first time, you will be seen within 2 weeks, something we are going to roll out across the country – just as if you suspect you have cancer.

If you are having a breakdown, if you are thinking of harming yourself, for any emergency which takes you to A&E, you’ll get the help you need – just as if you had gone to hospital with chest pains or following an accident.

These are big, big changes. And in Government again the Liberal Democrats will commit to completing this overhaul of our mental health services – ending the discrimination against mental health for good. And while I know not everyone in the party is going to agree, I can tell you now: I want this smack bang on the front page of our next manifesto.

This is a major step forward, and hopefully is the beginning of proper treatment for mental illness. The Chief Medical Officer recently pointed out that mental health is more than 50% underfunded by the government, and (with Clegg in government) funding is still being cut.

But lets get this in perspective. 18 weeks is 3024 hours. If you have a broken arm and report to A&E, you'll start getting treatment within 3 hours. People with depression will get anti-depressants before 18 weeks, but if you are down, anxious, possibly suicidal, an 18 week wait feels like an eternity. It's 1/3 of a year. It's unclear what the 6 week target is, but if that was the average wait then that would be a major step forward.

And, Clegg needs to make sure that the talking therapies themselves are therapeutic. Simply getting someone to a CBT counsellor after 18 weeks isn't enough. The counsellors themselves need to be well trained and competent. It's not a question of getting people into the system at the appointed time, or off the books after they've had their quota of 6 weeks of CBT. Mental health is usually a recurrent condition, and the practice of discharging patients, who then have to start all over again a year later when they've relapsed because there was no ongoing, low-level support, is counter-productive.

It's the nature of depression, anxiety and mental illness that people with it tend to shout about it less. We're less likely to let on to other people, and we're less likely to have the energy and confidence to complain about inadequate treatment, or lobby for something better. It tends to shrink your world, rather than expand it. Mental health needs consistent, well-informed advocacy from politicians and the wider community if it's going to cease being the Cindarella service.

The £120m pledged by Nick Clegg is a drop in the ocean, but given the current uninspiring choice between the main parties, if one of them is promising a thought-through plan and funding to raise mental health from non-league to championship status, then I'll be voting for them in 2015.

(PS, there was a good piece on Newsnight last night, including a report by Katharine Welby on mental health, in relation to Cleggs speech. It also touched on how mental illness is seen by the church. Worth a look, starts at 20min 50sec in.)

Update: some media coverage
Nick Robinson at the BBC ignores mental health completely
Ross Hawkins at the BBC has 7 words on it
the commentators simply don't seem interested.

The mental health 'car crash': a little more conversation, a lot more action.

The outgoing head of the Royal College of Psychiatrists is deeply unhappy with the way the Coalition government have handled mental health.

"It's a car crash," said Prof Bailey.

"The system is in crisis and we need people to listen.

"The sums of money that could make a difference are not huge but they could make a large difference."

Prof Bailey, who steps down as president of the Royal College of Psychiatrists later this week following three years in the role, strongly attacked the health secretary for failing to engage.

Asked whether Mr Hunt takes mental health seriously, she replied, "He has a basic understanding of it but whether he takes it seriously, the proof of which would be making it a priority, then sadly not."

There is the standard dead bat response from the government (that's a cricketing term, rather than anything to do with deceased flying mammals). It's even more frustrating to have a government that promised plenty on mental health but failed to deliver, than one which said nothing in the first place. Demand is rising, but provision is falling. If you thought the 4 hour wait in A&E for your broken leg was bad, you should be grateful it's your body that's broken and not your mind. We need both a little more conversation (there is still a great stigma over mental illness) and a lot more action.

It's very hard for people who are 'in the system' to speak out about it. For many with depression, anxiety etc., simply getting through the day is enough of a challenge, let alone having the confidence to challenge the system if it's letting you down. A few years ago, if you wanted my vote, a concrete promise of cash and provision in this area would have swung it. But until we get a health minister who has either been a patient or a carer for someone with acute mental health problems, I'm going to take the promises with a large pinch of salt. 

The recession has triggered a further rise in the number of people on anti-depressants. It's not hard to see how someone on a zero hours contract is going to get anxious, or a student facing an increasing mountain of debt, or a child struggling to hit the scores their school needs to top the league tables whilst their parents are splitting up and their so-called 'friends' are bullying them on Facebook. In most of these areas there are demand-side reforms to mental health (like this), but they don't always sit well with the austerity agenda. Mental ill-health costs £70 billion a year, according to the OECD. More than that, it's people's lives, and you can't put a price on that.

OCD is not a throwaway line

Being 'a bit OCD' seems to be turning up more and more in everyday conversation. It's a jolly way of saying you like things a bit neater or more in straight lines than the average person.

Except that's not what OCD is at all. A recent tweet by Stephen Fry along similar lines is discussed in this powerful piece by David Adam, where he examines what's wrong with talking about OCD as a minor behavioural quirk:

This matters for two reasons. First: the more that OCD is cemented in the public consciousness as a trivial and superficial tic, the more that misleading impression damages vulnerable people. It takes real courage to confront mental distress and seek help. Yet when people with OCD do so, they often find bafflement and hostility, even from within the medical profession. If OCD is simply someone who washes their hands then why is this patient telling me of unwanted thoughts to hurt their children? If OCD is someone who lines up their DVDs in alphabetical order, then is this teacher who wonders if she knocked someone down in her car last night and compulsively calls hospitals to make sure she didn't, safe to carry on working? Those aren't hypothetical examples. Parents with OCD are separated from their families. Workers are suspended from their jobs, but not because they pose any threat. One of the defining features of obsessive thoughts is that they are unwanted; we don't act on them. They get treated in that way because their symptoms either weren't recognised as OCD or because the reality of OCD was blurred by the popular misconception.

Second: people with OCD get their information from the same sources. We believe OCD is something else. If OCD is angst about symmetrical cakes then what is wrong with me? Why can't I shake these crazy ideas about catching HIV from my cat? Why do I think about having sex with next door's rabbit? Those too are genuine OCD examples. And here's the killer line: they are the kind of weird thoughts that everybody has from time to time. OCD is when they get stuck.

OCD is listed by the World Health Organisation as one of the 10 most debilitating illnesses in the world. Despite this, it's still mainly hidden, and misunderstood, Adam describes it as:

a disorder of thought: harrowing, distressing, torturing, impossible-to-shake thought. That's the O in OCD – obsession – and it's what causes most of the D from the same abbreviation. (It stands for disorder but means distress.) Ironically, the compulsions, the C in OCD, the most visible and least understood feature of the condition, are almost always what we do to make ourselves feel better. Compulsions are a response to an obsessive irrational thought.

We still don't know why our mental wiring goes disastrously wrong like this, and chemical and therapeutic treatments are still quite trial-and-error. Adam points out that there is a gap of over 10 years between people first experiencing the symptoms, and going for help (more of his story here). A lot of this is the stigma attached to mental health problems, particularly such extreme and irrational thoughts - who would want to own up to them? But this is a mainstream mental health problem, affecting roughly 1 in 100 people (probably more, as it's under-reported). 

So if you're just 'a bit OCD', be thankful, be very very thankful. 

Mental health - losing out yet again

story on the BBC website today:

Mental health trusts In England have had their funding cut by more than 2% in real terms over the past two years, figures show.

The BBC received data from 43 out of 51 mental health trusts following a Freedom of Information request.

The coalition has guaranteed the NHS budget will rise by 0.1% in real terms over the course of this parliament.

The Royal College of Psychiatrists is warning that mental health services are near breaking point.

Separate data for the same period shows referrals to crisis and community mental health teams have risen by 16%.

I really don't see how this squares with the stated commitment of the government to support mental health. Norman Lamb is quoted in the article  bemoaning the state of affairs, which I simply don't get at all. You're the government, in case you'd forgotten! 

High profile summits on dementia research are all very well, and a good thing, but just as important is the day by day support to the millions who already suffer from dementia, depression, anxiety, ocd etc. and for whom local mental health services might be the last thread holding them together. 

update: by 'coincidence' an e-newsletter from Mind and Soul just arrived. How to be a mental health friendly church, articles, testimonies, lots of helpful stuff. 

Dying of Embarassment

Cancer survival rates would be much better if we were less embarrassed about going to see the doctor, or were afraid of wasting doctors time, according to a new report.  I can vouch for this; it's taken the repeated encouragement of my other half to get me to the doctor on a couple of occasions in recent years when, left to my own devices, I'd have tried to soldier on and hope things went away. Partly because I didn't want to bother the doctor, and partly because there were certain bits of my anatomy I didn't want exposed to the fresh air of a doctors waiting room.

"As a nation we are much more likely to say we are embarrassed about going to the doctor or we are worried that we will take up a doctor's time.

"We don't know why British people feel like that. It may be that we are more stoic and have a war-time mentality.

"We know that older people in particular can get a symptom and then wait for weeks or months before going to see their doctor."

I must admit, the fear of wasting doctors time is sometimes reinforced by booking in systems, which sometimes seem designed to keep people away from seeing the doctor unless it's absolutely necessary. I appreciate the need to make sure doctors time is well spent, but there is still quite an air of mystique and remoteness about UK doctors. My experience in hospital is often (not always) that the specialists whizz in and out on the basis of spending the absolute minimum of time with a patient, and it's quite hard work sometimes to get information out of people about your condition. I don't know how highly social and emotional skills are ranked in doctors recruitment, but wonder whether a more overtly approachable medical  culture would help.

Despite that, I'm sure a some of it is down to the peculiar British culture of being obsessed by sex, whilst at the same time very squeamish about our own bodies, especially our (insert embarassment-saving euphemism here). And lets face it, a prostate check at a GP surgery isn't a pleasant experience for either party.

More of the report findings here.