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Mental Health in Schools

In many ways mental health problems are, often, best addressed in settings away from the formal structures and locations of the NHS.  Building support and understanding in the places where people spend much of their time such as work or educational settings has a particular benefit.

For young people, schools are a crucial setting and it has been an encouraging part of national policy in recent years to recognise this and to make some investment in building up the clinical and other capacity in schools to prioritise the need of young people with psychological and emotional difficulties.

This week I had the pleasure of speaking at the launch of an excellent new publication in the Tavistock Clinic series. Child Psychoanalytic Psychotherapy in Primary Schools covers a range of the experience of Tavistock staff working in primary schools, including mainstream and specialist provision.  It is a moving and powerful account of clinical work alongside a range of young people with significant difficulties which are impeding their capacity to develop both emotionally and educationally.

This topic has always been of particular interest to me, being the son of two primary school teachers.  As a child, the discussion at teatime was often dominated by my parents’ accounts of some of the most challenging pupils in their care and the difficulties they were experiencing.  Less formal help was available in those days and my parents often had to rely on their own common sense and intuition in dealing with those children and their families.   

Amongst every group of young people there will be a spectrum of psychological and emotional difficulties.  Many of these do not require a clinical response but there are a significant minority of children who do with the Department for Education estimating in 2019 that there are 14 children in the average primary school with difficulties at a level requiring highly specialist intervention.

At this age mental health difficulties rarely present as diagnosable conditions but, more frequently, as development problems in dealing with emotions and making relationships. At their root can often, though not always, be the legacy of some kind of trauma or other adverse childhood event.

As well as the issues for children themselves and their families, such difficulties often acted out through disruptive behaviours provides a real challenge for teachers and the school. It is tempting, but very destructive to respond in a punitive way to protect the learning experience of other children.

 Embedded clinical staff, including in this case, specialist child psychotherapists can offer significant help in this situation.  As well as providing individual or group therapy for some of the children and families with the greatest difficulties clinical staff can also provide a crucial pair of eyes, picking up clues and signals to help teachers and others better understand and respond to challenging behaviours.  Finally, there is the scope for clinical staff to provide support for teaching staff on how their process the emotional burden of their own work and the projected distress of young people.

The book which I would thoroughly recommend for anyone with an interest in children’s mental health and education describes in a way which is moving and accessible a detailed picture of this work.  It includes chapters from practitioners but also some very powerful interviews with family members including parents and kinship carers.

There are there are three themes I would like to highlight further.

The first relates to the significant stigma which still surrounds mental health difficulties, in particular when these manifest themselves through challenging behaviour.  Any parent will recognise the difficulty of having a “naughty child” but when this plays out constantly in any setting then it can create an unbearable burden for parents and other carers.  Families are reluctant to seek help and expose themselves to what they fear will be a judgment of their parenting.  This can be particularly acute for families with any previous experience of engagement with social services where they may judge difficulties may be the precursor to them losing their children.  The provision of support in a school setting can be a more reassuring offer which is easier to accept than a formal referral to CAMHS.

The second theme in the book is the importance of any school-based provision adapting itself to the constraints and rhythms of school life. This can be about space, the cycle of the terms and the starts and endings which are intrinsic to the school year.  It is also about the social dynamics of the school and details such as how children are taken out of class to attend therapy and how this impacts on the opinions of their peers.   For teachers the key strength of embedded provision is availability of clinical staff, the scope for informal consultations about children who are worrying them and the lack of barriers to escalation when required.

The final reflection is about the impact of the work and the nature of improvement in young people’s mod, behaviour and sense of wellbeing when it works.  Mental health work is not mechanical, and its impact can sometimes not be linear and progress can often be made in small steps.  Over time however those small steps can build to make a more fundamental change in a young person’s ability to manage their distress and participate in the social and educational life of the school. 

We know we face a big challenge around the mental health of the young generation.  There are some peculiar stressors facing the current generation and, despite new investment, there are very significant levels of unmet need.  There is such a compelling set of arguments to prioritise young people’s mental health.   As we develop what is available schools should be front and centre of our efforts.

Facing up to our past

History has been a major part of the public debate about race which has taken place since the death of George Floyd last summer.  Some of this has been about the emotive topic of statues but there has also been a wider and important conversation about the role of Britain in the slave trade and the wider consequences of our imperial past.

Some argue that history is irrelevant to a contemporary consideration of these issues: that then was then and now is now and that we, somehow, operate today without any reference to past.  I strongly disagree and, on this question, as on many others, I firmly believe that a knowledge of the past is crucial to a better understanding of what is happening in our own times.  

In this space I can thoroughly recommend David Olusoga’s Black and British as an excellent guide to the issues.  This is the best kind of history, broad in its sweep, compelling in its narrative and clear but balanced in its interpretation of events.  Despite all of this it is, at times, a difficult read for a white British, middle class reader, challenging both my ignorance and complacency about some significant events in the history of this country, events which still shape the present in which we live.

The book covers a lot of territory from the first attested evidence of people of black African descent living in Britain in the Roman period to the riots of the 1980s in London, Birmingham, Liverpool and Bristol.  It has, however, two overarching themes.  First that of British involvement in the transatlantic Slave Trade and the legacy that has left, both in Britain, across the world.  Secondly the attempt to give Black Britons of different generations, a place and a voice in history which, until recently, has been denied to them.

In 1844, at the peak of liberal Britain’s genuine but somewhat self-congratulatory pride in the abolition of slavery in British territories the future Prime Minister, Lord Palmerston said in a speech to the House of Commons:

“If all crimes which the human race has committed from creation down to the present day, were added together in one vast aggregate they would scarcely equal the amount of guilt which has been incurred by mankind in connection with this diabolical slave trade.”

In reading the description in Black and British of the trade and its consequences for millions of Black Africans I was driven to agree with this assessment.  We are used to using the Nazis and the Holocaust as the ultimate benchmark for evil, but I think it is hard not to look at African slavery and reach something of a similar conclusion about a trade in human beings which Britain played a leading role in for over 150 years, which underpinned a significant amount of the wealth of the country, and which was supported by much of the British establishment.

Britain also played a major role in the abolition of the slave trade and Olusoga is generous in his acknowledgement of this remarkable movement, not just its leading lights such as William Wilberforce, Thomas Clarkson and Granville Sharp but also the widespread public campaign represented by 1.5 million signatures on petitions calling for the abolition of the slave trade.  A movement which he adds involved, for one of the first times in British history, many women and, while often forgotten, black British campaigners such as Olaudah Equiano and Ottobah Cugoano.

However, it is not just through that lens that modern Britons need to learn about the slave trade.  We also need to face up to the details of a British trade, which in the 18th century alone, transported in appalling conditions 3.5 million Africans in 11,000 separate expeditions, stripping them of their liberty, dignity and in many cases their lives.  Nor can we attribute all the guilt for these events to slave traders and those who invested directly in the trade when so much of the commercial success of our country was built on the profits of slavery. 

This is not only about removing the statues of slave traders with any implication that we can erase those aspects of our history but about a determination to ensure these are events which we insist should be a core part of education for all and the story we tell about our identity as nation.   Just as it did for the abolitionists for whom education about the slave trade was a key aspect of their campaigning work, such a focus is not about diminishing our national identity but, in acknowledging all of our past, helping us strengthen the moral compass through which we look at contemporary events.

Olusoga, like all good historians, has resisted the temptation to write about more recent events.  However Black and British is not just a good history book.   It is highly relevant to thinking through our response to the challenges of confronting racism and inequality in the 21st century, issues which have their roots firmly in what has happened in the past.  Along with much I have learnt at first hand in my professional life in the last year, this book has taught me much about what I still need to do to be a champion of racial equality.  I am grateful for that, however uncomfortable are some of the truths I have had to face up to.    

Leaving Home

Last month marked a very significant rite of passage as we completed the sale of the house my parents had bought in August 1963 and in which I had spent virtually all of my childhood. 

I have written before of the impact that a sense of place has on our identity and, while I have chosen very much to identify with my Welsh roots, Birmingham and the West Midlands has done much to shape who I am.

Before the sale, I deliberately made a last visit to Solihull, in part to have the chance to say goodbye to the house and to some of the special places of my childhood.  Despite all the change in the wider world in that time, for the most part, they looked remarkably familiar and unchanged.  

I particularly enjoyed visiting some of the little wild places I had frequented as a child. Against the backdrop of suburban blandness, they provided such exciting places of escape.  I was still part of that lucky generation who were able to enjoy the freedom to roam at an early age, denied to my children, and Coldlands Wood (featured in the photograph at the top of this blog) was one of the places where I and my friends used to gather for all kinds of games of imagination (few of them probably would have passed a risk assessment). Those days sit at the centre of my memories of a happy childhood.

I had the chance too to walk past both my schools.  Both of them did a good job in helping to nurture my academic abilities and broader interests in life.  I particularly valued the emphasis my secondary school placed, not just on narrow academic achievement, but on music, drama and mountain walking, all of which have been lifelong pursuits.  I was lucky to be taught by many teachers whose commitment to their profession went well beyond the 9-5. 

The place has also left its mark on me.  As a child, and particularly a teenager, I had something of a love-hate relationship with Birmingham and Solihull.  The centre of Birmingham with its motorway moat and horrific subways was strikingly ugly in the 1970s (it has got better since) and the place could at times feel constraining and limiting.  By the time I went to University I was very keen to get away.

As is often the case, I have grown fonder of both since I left.  Birmingham is not the most beautiful city in the world but it has many strengths.  I was lucky to benefit from its strong cultural heritage: the CBSO, the Birmingham Rep, it’s lovely Art Gallery with its collection of pre-Raphaelites and its sporting venues such as Edgbaston and the Reddings (home of Moseley RFC and sadly now a housing estate).   It is a welcoming city and Brummies are, for the most part, friendly and down to earth.  Even the much-maligned Brummie accent is much more colourful and interesting when it is heard on local soil.

More than anything I love the sense of modesty and lack of pretension which I associate with the West Midlands character.  My mother always looked askance at people who she described as “having a bob on themselves”.  While proud of their city and its institutions Birmingham is happy to consider itself a “second city”.

Birmingham has always been a place which has attracted people from outside, my father included, and it was in Birmingham that I first learnt about diversity and the value of difference.  The presence of different communities in the city be they, Pakistani, Caribbean, Welsh or Irish very much felt they enhanced the city and added to its strength.  For me, as a teenager, that was epitomised by the bus ride from home, through Sparkhill and Sparkbrook to the centre of town.  While racism is no more absent in Birmingham than anywhere else, that positive image of different people, from different backgrounds sitting together on the bus has remained with me. 

In thinking back on my childhood and my time in the West Midlands my last thought has to be with my parents and the happy and stable home they created for us.  Like all families we had our challenges and issues but my parents did their best to give us the best start in life.  Many are not so lucky.

In many ways I left home when I was 18 and went to university and my parents never stood in the way of me making my own way in the world.  However, there was something reassuring over the years that they and my childhood home were still there and that I could return and recharge my emotional batteries. So inevitably there is some sense of adjustment now that they are no longer there and my connections with the city where I grew up are broken. 

Time to Change

It has been a special but sad experience to attend, in the last couple of weeks, a number of events to mark the end of Time to Change, the phenomenally successful programme which, since 2007, has been working to challenge mental health stigma and discrimination in this country. I had the honour, while I was at Rethink Mental Illness, of being closely involved in the establishment and development of the programme.  There is nothing I have done in my career which is more significant.

In sharing some of my thoughts about Time to Change it is right to start with the numbers.  Between 2007 and 2018 Time to Change achieved a 12.7% improvement in attitudes.  That is equivalent to 5.4 million people with improved attitudes.  That is a phenomenal level of change for a programme of this kind, especially one operating in an area where attitudes were seen as entrenched and constantly reinforced by negative stereotyping in the media.

These numbers are very much borne out in the reality of public discourse where it feels that there has been a sea change in the public willingness to talk about mental health and to accept those who are affected by mental health problems.  The programme has also always been concerned that any improvement in attitudes translates into improved experiences for those affected by mental health problems.  The reported experience of discrimination has always been a key part of the evaluation of the programme which fell by 11.5% over the first phase of the programme between 2007 and 2011 and which have shown further improvements since.

Success was not always guaranteed and there were many who were sceptical of the ability of such a programme to make a meaningful or sustainable difference.  After all attitudes towards mental illness, which had been tracked consistently in this country since the 1990s had either been static or declining.

The programme, however, got some important calls right.  I want to pick three, in particular.

There first was to base the programme on a commitment to partnerships.  Historically the sector had been very fragmented with a tendency to compete rather than collaborate.  The decision of the two largest charities in the sector Mind and Rethink Mental Illness to work together on the programme, rather than pursue separate initiatives, was significant as was the commitment of the rest of the sector to rally behind Time to Change.

Just as significantly there was a risk that the experiences of different types of mental illness might be seen as inimical to each other with a suspicion, for instance, that while it might be possible to shift public attitudes around anxiety and depression it would never be possible to do the same for schizophrenia.

Time to Change took the bigger picture and committed itself to the view that all aspects of mental illness would benefit from a shift in public attitudes.  For the most part that has been borne out.  This was not a case of picking easy middle of the road messaging with the aim of avoiding upset.  The programme made a conscious effort to deal with different narratives of lived experience.  I was particularly proud of the advert “Schizo the movie” which deliberately spoofed the horror film portrayals of mental illness only then to cut through to the everyday experience of someone living with schizophrenia preparing their breakfast.

A commitment to partnership also extended to thinking about the message of Time to Change was taken out into communities, workplaces and schools.  The Time to Change pledge, signed in the end by 1556 organisations employing 4 million people, was indicative of this approach.  Indeed, the world of work has been one of the areas where some of the greatest shifts in attitudes have occurred.  In 2006 a survey of employers by the Shaw Trust indicated that 41% of employers thought there would be nobody in their workplace affected by mental illness.  By 2010 that figure has fallen to 11%.

The second choice related to the commitment to evidence and evaluation.  The programme deliberately took account of the learning drawn from other international anti stigma work such as that in New Zealand and Scotland.  However, the decision to invest substantially in the evaluation of Time to Change was crucial to the sustained funding of the programme and to decisions about its direction and strategy.

The third and most important choice was to put lived experience at the heart of the programme.   The whole model of change for the programme was grounded on the principle of connecting people through the currency of personal stories of mental health problems and on the premise that where people knew others in their circle of families and friends their attitudes towards mental health problems tended to be more positive. 

It still takes some courage to share a personal experience of mental illness but that was so much more the case in 2007.  The bravery of those who first told their stories, both celebrities such as Stephen Fry, Alistair Campbell and Ruby Wax but also many ordinary people was so crucial in building the messaging and impact of Time to Change.  Those who made the first move opened the doors to others and there followed a flood of individuals in many different sectors of life:  sport, politics, business to name a few who stood up to share their own experience. As I know from our own family experience the normalising of conversations about mental health is, in its own right, a powerful therapeutic intervention.

As Time to Change comes to an end I have a number of reflections.

As I said, at the start of this blog, there is an enormous sense of privilege in being involved in such an important initiative and with such a special group of people.  Time to Change should not take all the credit for the change in attitudes towards mental health and the increased political priority and funding which has followed.  Its role, as a standard bearer for change, however has been undeniable.

Next there are lessons which can be drawn from what has been achieved in reducing mental health stigma and discrimination by those campaigning to deliver change in other areas such as poverty and race equality. 

Finally, there is the recognition that, despite what has been achieved, there is still much to do to tackle the stigma and discrimination relating to mental illness.  It is still time to change.

A long year – lessons from the pandemic

Anniversaries are always important times for reflection.

It’s been a year now since pandemic took hold and the decision was taken to start the first lockdown.  It’s almost hard to recall how dramatic those events were and how normal the constraints and reality of the last year have become.

In this country at least the pace of vaccination and the fall in the number of cases points to the possibility of moving out of lockdown and returning to some kind of life beyond the pandemic by the summer.

To mark that anniversary, I wanted to highlight some of the personal and professional lessons have I learnt from the last 12 months.

 It would not be an understatement to say that it has been a challenging time for most of us.  The worst of it, from a personal perspective, was the loss of my mother, last June. The issue was not so much the fact of her death in itself, she was 92 and had dementia.  Rather it was the impact the pandemic and the lockdown restrictions had on the quality of her last months of life and the constraints it placed on our ability as a family to be with her at the end and to mark her passing with the normal rituals of grief. Many families have been through the same or worse.

In other respects, I have been lucky.  I and the rest of my family have kept well.  I have continued in employment and have been able to adapt pretty easily to working largely from home.  While it has not been an easy year for my children, they are grown up and have not had to experience the major disruption to education and life chances that others have had to cope with. 

So, what are the wider lessons from what we have been through.

The first is to acknowledge the positives of how we have collectively coped and adapted.  I have seen that very clearly in the NHS where I work.  Staff have moved mountains to continue to care for patients, despite unprecedented levels of need and major practical and emotional stresses, and in some cases heightened levels of personal risk, in doing so. The same is true of many public services, in the fullest sense of the word, which have kept the essentials of life going through the last year.

That is not to ignore the mistakes which have been made. I, for one, favour some kind of public inquiry into the pandemic, not because I want to find scapegoats but because it is crucial that we learn the lessons of what has happened.  One thing that is clear is that, as a country, we were not adequately prepared for the pandemic and it would be negligent to assume that this kind of threat will not happen again, even if we emerge relatively soon from the acute phase of this crisis.

So, beyond the general experience what have been the more specific lessons.  I want to pick out three.  There are, of course, many more.

The first is inequalities.  The pandemic has highlighted very graphically the extent and impact of inequalities in Britain.  Mortality from Covid 19 has been much higher in minority ethnic communities and, for all sorts of systemic factors, the burden of the pandemic has fallen heavily on poorer socio-economic groups.  The pandemic has highlighted the economic fragility of many individuals and families dependent on benefits or low paid and insecure employment.  While the short-term measures taken by the Government to alleviate the economic consequences of lockdown have been significant and welcome there is real risk that the longer-term economic consequences of the pandemic will be felt disproportionately by lower income families and that inequalities are, as a result, further increased.  We ignore this at our peril.

My second lesson is around the importance of local places and communities.  In the last 12 months I have spent more time in the place I live than any time since the 1970s.  On the whole it has been a positive experience which has made me much more appreciative of my immediate surroundings.  I hope the world after the pandemic will have more of a local focus and that the move to blended models of work will allow us to eliminate the need for many unnecessary journeys. 

However, there will also be challenges.  It is hard to know exactly how radical the changes will be in our patterns of living and what the consequences will be for the physical infrastructure of our cities and towns.  Many urban places owe their origins to being focal points for trade and exchange and this could be under a profound threat if the shift from the high street to online commerce accelerates further.  There is again a real threat that such changes will further exacerbate inequality and impact disproportionately on communities that have already been hollowed out as a result of deindustrialisation.

My third point relates to the media and the quality of public discourse.  The pandemic appears to have worsened a trend towards an ever more polarised and intolerant level of public debate.  The voracious appetite of the media to fill a 24-hour news cycle and the impact of social media has fed on and fostered a collective sense of anxiety.  We need to reflect on what we can do to correct this and to create a space where facts and the nuance of legitimate difference between points of view are given greater prominence.

Like wars, the pandemic has been a collective period of trauma.  How we deal with the aftermath of that experience will have much to say on what its long terms consequences for our society will be.  Good things can come out of bad experiences.  The First World War gave women the vote, the Second World War gave us the NHS and the modern Welfare State.  What is it that we most want to create as the legacy to the pandemic and what is our collective will to create it?  That is the big question for the next 12 months.

The Dig

Like many others I enjoyed the portrayal of the discovery of the Sutton Hoo burial in the Netflix film “The Dig”. Sutton Hoo remains one of the most spectacular archaeological discoveries in this country and its circumstances need little elaboration to make excellent drama.

When I was at University, I was involved quite a lot in archaeology.  Watching “The Dig” reminded me of some of what was very special about excavation and the world of archaeology.  This blog shares some of those reflections.

Archaeology is an interesting discipline: one third craft, one third science, one third poetry. 

The aspect of craft is epitomised by someone like Basil Brown, the self-taught local archaeologist in “The Dig” whose knowledge of landscapes, and above all soils, and mastery of the  technical skills of excavation are more than a match for his academic (and social) superiors.  I was lucky enough to work alongside real craftsmen on some of the excavations I attended.  Those were the days when the archaeological workforce was often a mixture of students, like me, and unemployed people on Manpower Services Commission schemes.  One individual, in particular, stands out in my memory, the neatness of whose digging and the clarity of the features he exposed was outstanding.

Science is also central. Archaeology is many ways a magpie discipline using wider developments to help address its own questions and there have been big developments since the time I was involved in excavations. 

The secret to archaeological interpretation is stratigraphy and the ability to distinguish different layers of activity on a site and to date them by linking them to an independently verifiable point in time.  The introduction of radiocarbon dating at the end of the 1940s was the major breakthrough in this respect and over time the sophistication of this techniques and other approaches to the scientific dating of artefacts have increased enormously.

Similarly geophysical surveys have opened up the ability to explore sites without invasive excavation which by necessity destroys the evidence it is investigating.  While much archaeology these days is done in advance of development there is sometimes a question about whether it is the right thing to open up a site or whether it is better to wait until the development of techniques allow less invasive exploration. 

Finally, there is the poetry.  Archaeology is inevitably partial in what it can tell us about the past.  There is an enormous space for interpretation which still requires imagination and creativity. From my experience much of that task is carried out in the pub.  I have very fond memories of evenings listening, over a few beers, to lively debates about what the finds on the site we were excavating meant in terms of the activities of our ancestors.  There was a particular frisson to discussions around features described as “ritual”.  In part it was an archaeological catch all term for things for which there was no practical explanation for what has been found, but it was also a lovely reminder of how our species has always been interested in more than the utilitarian aspects of life.

I have three other observations about archaeology and how it has helped shape, for me, a wider view of life.

The first relates to the issue of migration.  One of the constant challenges for archaeological interpretation, in particular in the absence of historical records, is whether changes in material culture are the product of the movement of people or just of ideas and objects.  With the growing precision of DNA analysis this debate has become more sophisticated.  Whatever the events in any given period the archaeological record highlights the ubiquitous nature of movement and exchange as the catalyst for human development and challenges the simplistic concepts of national identity.

The second is the democratic impact of archaeology.  While the eye may be captured by high status discoveries such as Sutton Hoo, most archaeological discoveries relate to ordinary activities and ordinary people, people who, in most periods, would have left no other record of their lives.  Archaeological discoveries have broadened our understanding of periods with no or only limited historical records and of people and activities that would otherwise have remained invisible to us.  Those discoveries have helped us to rebalance our understanding of certain periods and corrected some of the inevitable  biases of historical accounts.

The final observation is how much archaeology has to do with death.  Burials and burial rituals, such of those of the ship at Sutton Hoo, form a major part of the archaeological record.  They cast a light on the most significant event for any of us and the beliefs which different generations and communities have had about the meaning of death, what might come beyond and the ongoing presence of our ancestors in the world.  Those windows into the beliefs of those who have gone before about death and mortality can help us in how we interpret that most inevitable reality of our own lives.

The highlight of my archaeological career was when I was given the chance to excavate the central burial in a Bronze Age round barrow at a site just outside Radley near Oxford.  The burial contained an intact beaker pot, one of the most iconic objects from any period of history, and the skeleton of a young child.  It was a very profound moment to have the privilege of contemplating, at the remove of several thousand years, another life, cut short all too early but nonetheless special. It is memory which will live with me all of my life.

The Matter of Wales

Few writers understand the issues of identity better than the late Jan Morris and nowhere more so than in her descriptions of Wales and Welshness.  In this she demonstrates a lovely ability to think of Wales from both “inside”, proud of her own Welsh identity, but also from “outside” in an observant and detached way bringing out the essence of this place and its people. Inspired by that example I thought I would have an attempt, for this St David’s Day blog, of offering my own reflections about the character of Wales.

Like Jan Morris my Welsh identity has an element of inside and outside.  Like her I have a Welsh father and an English mother.  I have never lived in Wales, but I have visited Wales virtually every year of my life (2020 for obvious reasons being one of the few exceptions).  I have routinely mixed with Welsh family and friends and have, as an adult, learnt the language which every previous generation of my Welsh family has been able to speak.  And yet I can also approach Wales with the eye of other identities.

There are many aspects of Wales it would be possible to comment on but for this blog I want to pick out four.

The first is size.  By any standards Wales is a small country.  Yet within a small country there is a remarkable diversity of places, landscapes, people and identities.  The geography of the country reinforces this with mountains often protecting the separateness of different communities. It is a long-held truth that it is easier to get from South to North Wales via England than directly through Wales, but that sense of very local identity goes much deeper.  It is a special quality which contributes to the distinctive beauty of the country although it has perhaps not always helped our attempts at self-government.

The second, perhaps related, point is around the sense of community.  This is a palpable part of Welsh identity and Welsh politics.  It is not surprising that the two politicians who played the greatest part in establishing a universal system of health care in the United Kingdom, David Lloyd-George and Aneurin Bevan were Welsh.  My father was always proud that, despite the wider material poverty he experienced growing up in the Rhondda in the 1930s, that his community had organised a system of access to healthcare, funded by contributions from other working men years before the establishment of the NHS.  It is, for the most part, a country with a concern for the poor, disabled and disadvantaged. 

The third is a love of music and poetry.  Whether in eisteddfodau or on the rugby field Wales is indeed “Gwlad beirdd a chantorion”, “a country of poets and musicians”.   At the same time, culture, has, for the most part, a more democratic feel in Wales than in some other places and it is a country which is happy to see those who excel in poetry and music as some of its greatest lights.  

My final point is around a sense of the past.  It is not difficult to feel close to the past in Wales and I always have a strong sense of the ghosts of previous ages and people when I travel round the country.  More than other countries the history of Wales is, in part defined, by a strong sense of clinging onto to a place and identity which could so easily be washed away by the tides of the modern world.  Dafydd Iwan’s alternative Welsh National Anthem “Yma o hyd” epitomises this with its rousing chorus “er gwaetha pawb a phopeth ry’ni yma o hyd” “despite everyone and everything we’re still here”.  Nothing characterises this more than the battle to maintain the Welsh language which, as the defining achievement of Welsh nationalism, has succeeded in defying the gravity of history.  

So where does Wales find itself in 2021, after 20 years of devolution and with the wider changes in the UK following Brexit.  I start by declaring my support, at present, for the maintaining the Union which I still believe is in the interests of all parts of the United Kingdom.  However, it is not something which can be taken for granted and there is no doubt that there is growing and genuine support in Wales for the idea of independence, reinforced by a strong sense that both Scotland and Northern Ireland are, post Brexit, on an inevitable course to leaving the Union and with a UK Government, for its own reasons, playing the card of English nationalism.

I have, by contrast, always been a strong supporter of devolution.  It has been a positive development in the last year for the distinctive actions of the Welsh Government to become more visible at a UK level.  For me the case for independence has to be made in Wales, through deeds and not just words and with a clear vision of what would be different about a separate Welsh state including how it would protect the economic interests of the country.  The desire for independence must never be just a function of the resentment of London based politicians and media.  

The real challenge for Wales and Welshness is how it can define itself confidently and proactively and not just in terms of its relationship with England.  In the past this has manifested itself in the establishment of distinctive Welsh ideas and institutions, of Welsh leaders such as Lloyd George and Bevan who can also be leaders of a wider nation and of cultural figures such as Dylan and RS Thomas who can hold their own on a wider stage. 

Wales can and should hold its head high in the modern world.

Mae hen wlad fy nhadau yn annwyl i mi.

What if there is life on Mars?

It has been difficult to avoid a sense of excitement about the landing of the Perseverance rover on the surface of Mars, particularly so when you’re part of that generation which grew up with the Apollo moon landings.  There is something totally compelling about the continuing story of mankind pushing the boundaries of knowledge of worlds beyond our own and the technical wizardry of landing and operating the rover at a distance of 130 million miles.  And then, this time, there is also the genuine possibility of finding evidence of other forms of life as the rover explores a part of the Red Planet which demonstrates historic characteristics which might have been capable, in the past, of supporting it.

In our imagination there are few more potent questions than that of the possibility of finding life beyond our planet.  In part this is a feature of man’s enduring curiosity, but it also points to a much deeper existential concern.  In particular as the presence of religion fades in our societies and our knowledge of the vastness of the universe increases the question of whether intelligent life has developed elsewhere or whether we exist in a peculiar isolation becomes ever more intriguing.

If Perseverance finds evidence of life it is likely to be extinct, a product of more benign times on Mars which may have been conducive to the development of life.  Nonetheless such a discovery would be immensely profound demonstrating clearly that the existence of life is not a singularity and that there might well be intelligent life elsewhere.

I am not sure this will be a question which will be answered in my lifetime, but the pursuit of an answer is profoundly fascinating.  However, at the same time, it is also worth asking what might it be like meeting another sentient form of life be like and what do other experiences in our history have to say about that?

The precedents are not that encouraging.  Whether it’s the extinction of neanderthals, the arrival of europeans in the Americas or more contemporary expressions of intolerance, our species can display a disturbing inability to co-exist peacefully with others and, just as frighteningly, an ability to justify our actions in doing so.  If we can not readily accept those of our own species with different skin colours, who speak different languages or practice different customs why do we think it will work out well if we were to meet aliens (itself a totally loaded word) from other worlds?

Science fiction, which I have always found quite a profound artistic medium, has provided some compelling insights into what that moment of meeting another intelligent species might be like. For instance, the iconic 1951 film The day the Earth stood still, while it uses the presence of extra-terrestrial visitors to communicate a wider message about the danger of nuclear weapons, creates a very powerful sense of the incomprehension and paranoia which might accompany an encounter with another form of intelligent life.  Even my favourite science fiction series, Dr Who is not short of examples of how ambiguous mankind might be in their dealings with those from outer space.  On many occasions it takes the Doctor with his greater intergalactic wisdom to counsel the Brigadier and other human characters from thinking that blowing them to smithereens is the only effective form of communication with aliens.

As our exploration of worlds beyond our own again gathers pace it will be important to reappraise our purpose and motivation in doing so.  Is this a matter solely of scientific exploration or will be quickly drawn into another phase of colonialism and exploitation, the legacy of which, on our planet, is so contentious?  We might be able to do both and if we are exploiting genuinely empty worlds it may not matter.  However, Columbus was seen initially as explorer and the principle of terra nullius (no one’s land) was used in a cavalier manner to justify great swathes of western colonialism.  If we ever meet another species will we again be drawn to exploit their resources, labour and freedom as we have done in our own world?

For me this also points to another aspect of the modern world.  We live in age of enormous technological development where, in so many fields, what we can do as a species has been transformed out of all recognition.  However, I am not sure that our moral science or systems of governance have kept up at the same pace.  Scientists, like the rest of us, can have clay feet and how we arbitrate what the consequences of scientific and technological discoveries has become increasingly difficult, especially in an increasingly interconnected and fast-moving world.  As a distinctively social species, Aristotle’s “political animals”, the systems of morality and collective decision making we put in place to govern our affairs are of crucial importance and justify just as much attention as scientific discovery and technological innovation.

I don’t expect to meet a man from outer space but the possibility of doing so and the establishment of clear purpose in our ventures to other worlds requires moral as well as scientific exploration.  While we are doing so, we could also ask ourselves the question of why, when we can land a rover on a planet 130 million miles away, we cannot tackle problems closer to home, for instance ensuring that every child has enough to eat?

Let us not forget

On the whole I have focused my interest in the history of the great conflicts of the 20th century on the First World War.  Exposed, as a young person, to the haunting imagery of the war poets and to first-hand accounts from relatives who took part in the conflict, the Great War has always represented for me the definition of the tragedy and, in part, futility of war.

This year during Lockdown I decided to refresh my knowledge of the Second World War, aided by Anthony Beevor’s brilliant and epic histories and, latterly, discovering the mesmerising accounts of the Russian wartime correspondent Vasily Grossman.

I have always had a reasonable knowledge of the key events of World War 2 but I rapidly realised, through what I have read this year, that there was something missing in my perspective of the conflict. 

I don’t think I am alone in this country in that respect.  In all my lifetime we have made a particular point of celebrating Britain’s contribution to the defeat of Nazi Germany as our “finest hour”. Significant while Britain’s role was, especially in the early years of the War, this picture fails to take account of the real scale of the conflict, the unbelievable horrors committed during its course and the phenomenal loss of life in other parts of the world, in particular in the USSR and China.

This was the bloodiest conflict in the history of human history, claiming at least 60 million lives across the World, including 20 million in the USSR (nearly 14% of the population).  While, with hindsight, the defeat of Nazi Germany (and Imperial Japan) can seem inevitable given the, eventually, enormous superiority of men and armaments put together by the Allies.   However, at the time, it must have seemed far less certain and many cases of individual sacrifice were required before victory was secured.

The Second World War also witnessed some of the most frightening and brutal examples of human violence and cruelty ever perpetrated.  Although the worst examples undoubtedly rest with the Nazi, and Japanese, regimes, few combatant nations passed through the war without something that might trouble the national conscience. This includes the mass pillage and rape carried out by victorious Russian troops in Germany or, in our case, the systematic area bombing of German cities.  In some cases, there was some justification, for instance in relation to the decision of Harry Truman to drop nuclear weapons on Japan but in other cases they were products of the brutality of total war.

At the same time, the Second World War witnessed phenomenal acts of bravery and personal sacrifice.  Vasily Grossman made his reputation through his coverage of the Soviet defence of Stalingrad.  In what must count as the fiercest battle in history, Grossman highlights examples of the desperate courage of Russian defenders which, perhaps, more than anything other one event, represented the turning point in the fortunes of the War.  Such courage is also displayed in respect of actions to defend Jews and other groups singled out by the Nazis.  When Grossman revisits his hometown of Berdichev in the Ukraine and discovers that 30,000 Jewish inhabitants, including his own mother, have been massacred he also reflects that those Jews who have survived have done so through the help of local Russians and Ukrainians who risked their own lives to offer protection.

No part of Vasily Grossman’s narrative is more moving than that which he wrote in the wake of witnessing the discovery of Treblinka, one of the first of the concentration camps to be “liberated”.  I have, perhaps, been guilty, at times, of thinking of the Holocaust in too detached a way.  There was something in reading Grossman’s account which brought out the raw and physically repulsive nature of what he witnessed as the absolute paradigm of human evil. There is no way we must ever let its memory fade.

The Second World War was different from the First.  In the First it is difficult, at times, to determine what were the ends which sent so many of Europe’s young men to their deaths.  In the Second, the ends are clear and there was an unassailable morale argument that, once the nature of Hitler’s horrific regime had emerged, action was required to stop it.  There was a moral challenge, however, at times through in respect of whether those ends justified all the means required to topple the Nazis.  A challenge brought to the fore by the need to collaborate with the evil of Stalin and his regime.

For the West at least, the aftermath of the Second World War has been much better than had been the case in 1918. Whereas the settlement of the First World War sowed the seeds of a further, more calamitous conflict, within a generation, Europe has managed, since 1945, to enjoy, with the exception of the wars in the former Yugoslavia, a period of unbroken peace.  One of the most significant figures during the War and its immediate aftermath was the American, George Marshall, Chief of Staff of the US Army and “organizer of victory” and, as US Secretary of State in Truman’s Government after the War, author of the eponymous Marshall Plan which did so much to contribute to European peace and prosperity.

Reading in more depth about the Second World War has reminded me of why the events of the last decade, and the echoes they have brought of the economic and political woes which led to the rise of Hitler and the horrors of that conflict have been so concerning. 

On this Remembrance Day it is right that we remember the enormity of the sacrifices which have been made in previous conflicts but also to remember what they were for and to do what we need to do, in our generation, to ensure that the World never has to witness again what it had to see in the dark years of the early 1940s.

We could just be happy

One of the most special parts of the day I spent, a couple of weeks ago, celebrating the centenary of the Tavistock Clinic was a session we had talking about involvement in the Trust.  A number of our service users who have been actively involved in the work of Trust attended the session and make some brilliant observations about their experiences. 

Something about the dynamics of it being a centenary event made it very different from other sessions of that kind with a much stronger sense of equality than usually exists between those who provide services and those who use them.

At the end of the session the question was posed about what our aspirations were for the next hundred years of the Tavistock’s work and indeed for mental health and mental health services, more generally.  One of our service users, Julie, struck me particularly with her answer “Perhaps, by then, we could just be happy.” 

Julie was particularly concerned by the impact of stigma on those who are struggling with mental health problems and how this significantly intensified the distress which people experienced.  The remark however opened, for me, a wider question of how, in both mental health services and in life more generally we deliberately create an environment which gravitates against wellbeing and encourages mental distress.

I wanted to draw out a couple of points.

One of the words I have heard most often from people who use services is that of judgement.  How, whether in their experience of services or in their wider lives, the sense of being judged has added to their distress and, by converse, how opportunities they have had to engage in non-judgemental therapeutic relationships or other activities have been central to their recovery. 

Linked to this is the issue of expectations.  Positive expectations can, at times, be a very positive thing, giving people the confidence to move forward and achieve things in their lives which they thought were beyond them.  It can be a very double-edged sword and many people in distress struggled with the weight of unrealistic or even malicious expectations. Amongst these, unattainable expectations of perfect happiness can, ironically, be some of the things which lead to the greatest unhappiness.

A second theme relates to stereotyping.  This is central to the experience of stigma for people with mental health problems where a negative stereotype of mental illness, in general, or of particular conditions can reinforce distress or inhibit recovery.  Stereotypes affect many other aspects of life whether in relation to race, class, gender or other characteristics. Negative assumptions about individuals made consciously or unconsciously in this respect are both hurtful and can limit an individual’s experience or ambition.

A third area is the cultivation of anxiety. As I have written in other blogs, anxiety is an important human characteristic which in the right doses helps us to anticipate future problems.  However, in excess, or out of control, it can be very destructive.  It is clear to me that we live in an age of anxiety, often fuelled by the behaviour of our media and their constant search for headlines, and now given a new twist by social media.  During the last months of the pandemic the dominance of sensation and scaremongering over rationale debate and reassurance has been, from a psychological perspective, one of the most damaging features of what has been happening to us. Such an atmosphere is especially challenging for those who already are struggling with anxiety.

All of this highlights for me the need to put a focus on wellbeing and happiness, however difficult they are to define as concepts, at the centre of public discourse as well as how we think about services.  A couple of years ago there was a period of interest, championed by thinkers such as Richard Layard, on elevating wellbeing as a determinant of public policy, above or at least equivalent to other priorities such as growth in GDP, or in the case of healthcare the simple preservation of life.

Such a narrative appears to have lost its way, as if we can only think of happiness in times of wellbeing and prosperity.  Yet it is times of adversity we most need a focus on wellbeing in ways which support our resilience.  There are occasional echoes of this in the current debates about the pandemic but too often this aspect is crowded out.  Nothing epitomises this more for me than the issue of the rules around visiting older people in care homes. As was borne out by the experience of my mother who died earlier in the summer, the presence of loved ones at the end of life is of particular importance.   

There is also an individual dimension to this.  The choices and priorities we make in our own lives and the insights we gain into to our characters which best help us maintain our psychological equilibrium in the face of adversity, are crucially important.  The focus which the ancients gave to understanding “the good life” and the moral attitudes and response which support it, is depressingly absent in modern life.

Life can be very uneven and unfair and there is no magic wand we can wave to guarantee happiness but as an attitude of mind it is the right approach.  We live only once, and it seems wrong not to do what we can to try to be happy ourselves and undertake the actions which promote the happiness of others.