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German Wings

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Like many involved in the battle to change attitudes towards mental illness, my heart sank on Friday morning when, walking through Clapham Junction Station, I caught sight of the day’s newspaper headlines.  In language at the best sensationalist and in many cases judgemental and stigmatising they made the claim that the Tuesday’s tragic crash of the German Wings flight from Barcelona to Dusseldorf could be blamed on a man, the co-pilot Andreas Lubitz, suffering from severe depression.

So after years of improving attitudes and improving media coverage, even in the tabloids, here we were back again in the bad all days where mental illness could be freely demonised and where gross stereotypes could be applied to those affected.  I have always disliked the kind of media scrum which follows a high profile tragedy like Tuesday’s crash where the media chase after every possible detail and angle on the story and where the currency of competition tends to be expressed in terms of the sensationalism of the headline or comment.

It is expected that the journey to change attitudes towards mental illness will take some twists.  As I know well from my professional experience the narrative is not a totally simple one.  Mental Illness can have a destructive impact, most often on the individual themselves, but in a small number of cases on those around the person.  Such experiences must be understood and talked about but they do not justify blanket statements and stereotypes which have such a negative impact on people living with mental health problems.

We do not know, nor perhaps will we ever know, exactly what happened on that flight on Tuesday nor what was going through the mind of Andreas Lubitz.  What is certain is that it was a horrific tragedy for the 150 people on board and their families.   Having flown myself last weekend the news struck me all the more forcibly with that sense of the narrow lines of fate which divide the lucky from the unlucky in life.  Flying is still a relatively recent achievement of mankind and there is still a deep seated superstition about it and morbid fascination about accidents which we do not direct to many of the mundane things which claim many more human lives each year.  Despite what it involves flying is a remarkably safe activity.  There will be lessons to learn from this incident but I also wish we would get as excited by motorists using mobile phones when they are driving.

The bold assertion made by some parts of the media is that it was outrageous that Andreas Lubitz, having a history of depression, should have been allowed to fly.  Would the same have been said if he had been suffering from diabetes or another long term condition where, if badly managed, there is a risk of serious consequences?  There are clearly circumstances where someone’s state of health means that they are unfit to carry out their job, especially if that job had the level of responsibility associated with being an airline pilot.  Such judgements should be specific though to individual circumstances not a blanket exclusion of people with a history of a particular condition.

Depression is after all the most common mental health condition.  Worldwide 8-12% of us should expect to experience it in our lifetimes.  There are people with a history of depression in many if not all walks of life.   It is no surprise to find that there are airline pilots who have suffered from it and there is no specific reason why, as a result, they should not be allowed to fly.  It is, in many cases, a very treatable condition.

That is a link to the two final points I wish to make.  Depression is a treatable condition but there is an enormous scandal about access to that treatment with more than 70% of people with the condition unlikely to be offered any form of treatment.  The comparable figure for diabetes is less than 10%.  There is an enormous economic and other consequence of that institutional bias against mental health. That lack of access to treatment  is also probably the biggest single cause of the more than 4,000 lives lost through suicide each in this country.

The second point relates to disclosure.  As I have said, there is insufficient detail to know exactly what happened with Andreas Lubitz.  I have a sense that however that he may not have been in a position to be open about his issues as might have been ideal.  Disclosure is difficult.  While stigma is common and stereotypes abound there are lots of reasons why people feel that they cannot disclose a history of mental health issues.    As I know from personal experience undisclosed issues are much harder to support and make it more difficult to put in place the reasonable adjustments which can make a crucial difference in the working life of someone who is living with a mental health condition such as depression.  Friday’s coverage will have discouraged many more to be open about a history of mental illness.

By the end of the day having seen some of the response on social media and elsewhere I felt more reassured that, while a setback, Friday’s media coverage of this story was not a reversal of the progress which campaigns such as Time to Change have made.  It does show how much is still to be done.

It’s time Cinderella came to the ball

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There are few areas where the health and social care system can make a bigger difference than in supporting young people with mental health and emotional difficulties. On the latest count nearly 10% of children and young people will experience a diagnosable mental health problem and yet we only spend £0.7 billion or 6% of the NHS mental health budget on this area of care. If we get it right in providing young people the help they need we can make a difference to their immediate distress and that of their families. We can also increase the chance that they will successfully complete their education and enter adult life and the world of work with the same chances as their peers. Get it wrong, as I am afraid we in too many cases now, we can condemn some young people to a lifetime of underachievement and with 50% of adult mental health problems developing before the age of 14, trap some people into a history of using of adult mental health services.

For the last 6 months I have been involved in the Children and Young People’s Mental Health Taskforce, whose report is published today. Born in part in response to shocking stories last summer of young people in severe distress having to travel hundreds of miles to access an inpatient bed or even worse being detained in a police station when no beds were available, the Taskforce I hope marks a turning point in the fortunes of this Cinderella of Cinderella services. The news over the weekend that the Taskforce’s report would be accompanied by some financial commitment in the budget has increased my optimism that this may be the case.

Working on the Taskforce revealed a deep commitment and consensus across experts drawn from health, social care and education about what was needed to improve care, and above all outcomes for young people. That view was reinforced by the strong messages from children and young people themselves and from their families about what needed to change.

A number of points stand out.

First the compelling case for investment in an area which has been historically underfunded, has been disinvested in the years of austerity and where the case for the long term benefits of improving access and outcomes for children and young people are compelling. We have known for some time, for instance, that the costs of crime of adult with conduct problems in childhood might be as high as £60 billion per annum and yet we are failing to make the investment in the proven interventions which could make a real difference in the future in reducing that cost.

Second that this area needs the same focus on integration as we are beginning to bring to the care of frail older people. Joint commissioning, which also embraces the money which is spent by schools on supporting young people with mental health problems is crucial if we are to create a system which is up to the task of meeting the needs of children and young people. Joined up provision is also crucial. The role of schools and other universal provision for young people is central. Teachers need training and support to manage the pupils in their care with mental health problems and specialist services in CAMHS should link with schools to provide training, advice and easy routes of referral for those young people whose difficulties need more complex intervention.

Third that the old model of CAMHS, based on the four tiers of response, is no longer fit for purpose. While well intentioned, it has created a system which is over complex and baffling for young people and their families attempting to seek help. I liken it to the experience of a salmon trying to swim upstream against the curent with young people having to fight to show how ill they are to access the necessary help.

Over the last year we have been involved in working at the Tavistock and Portman, together with colleagues from the Anna Freud Centre, to develop a new approach to CAMHS, the Thrive model. Thrive looks to identify not levels of need but rather the purpose of care. By using careful assessment and shared decision making it focuses on helping to distinguish those young people who can be helped with advice and signposting towards self-help resources, those who can benefit from routine treatment and those with more complex needs who need longer term support including those for whom therapy may not deliver immediate benefits but who because of the level of risk they present with still need to be held safely in the system and supported other goals in life. I hope Thrive can play a significant role in improving access and outcomes by facilitating integrated working, working in partnership with young people and their families and making the best use of the specialist clinical resources available and the wider resources which exist in the voluntary sector and elsewhere in the community.

My final point relates to the need for us as a society to stand back and reflect on our wider aspirations for young people. There is no doubt for me that, on the whole, the stresses on young people today are greater than when I was a teenager in the 1970s. The world is less innocent and our expectations on what young people will achieve is greater. There is a need, not just to look at how we respond to the inevitable mental health and emotional difficulties which will emerge, but to focus on resilience; how we equip young people to handle the stress they face and in some cases to change the way we do things to reduce it. Attitudes towards mental health and emotional wellbeing are crucial. My work with Time to Change, and the experience of my own children, convinced me that young people are in many cases more knowledgeable about mental health issues and more sympathetic to those affected than my generation would have been. However there is much to do to build on that and, in particular, to change the attitudes of some of the adults around them whose response is key when those young people experience difficulty.

The Taskforce report and the welcome prospect of a commitment for additional funding are very important step forward but it will be crucial this area is something which any new Government, after May, also makes a priority. Society as whole is the winner if we get children and young people’s mental health right. It’s time Cinderella was invited to the ball.

A voice for Mental Health in London

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London is a special place.  One of the world’s great world’s cities and central to the economy of the UK, Europe and, in some respects, the world.  It is also a city with its own very specific issues  in relation to mental health.

At the end of February the 10 Mental Health Trusts in London came together to launch the Cavendish Square Group as a new voice for mental health in capital.  In doing so we believe there much more we could do, collectively, to raise the profile of mental health as priority in London, advocate on behalf of people who need help and services and celebrate some of the important activities which, whether in the fields of research, clinical services or training and education, are based in the capital.

A city as large, diverse and pressured as London undoubtedly is, will always face specific challenges in relation to mental health.  The risk factors for various forms of mental illness are higher than in other parts of the country.  Research is clear, for instance, that rates of psychosis will be higher in urban areas, in areas large with BME communities which may be experiencing discrimination and poverty or where risk factors such as the consumption of cannabis are particularly prevalent.  London has all these features in spades and this is reflected in the level of demand experienced by London’s mental health services.

The issue of mental health has a wider relevance however for a city such as London.  Mental health and emotional difficulties are crucial barriers to the successful development of the capital’s young people.  Around  1 in 10 of young people in London , or  something like 110,000 individuals, are thought to have a clinically significant mental health problem and the impact of childhood psychiatric disorders cost London’s education system around £200 million each year, in addition to the impact such issues have on the lives and lifetime prospects of the individuals concerned.

Mental health problems are also the biggest single reason for lost productivity in London’s labour force.  This is something which good employers are becoming increasingly aware of and beginning to tackle  but there is much still to do both in terms of providing effective support for people with mental health problems in the workplace and also in reducing the stigma which prevents employees from being willing to disclose problems in the first place.

Finally good mental health is fundamental to the physical health of the capital.  The burdens on the city’s hospitals are significantly increased by the impact of co-morbid mental health issues, whether in terms of the 65,000 Londoners living with dementia or the even greater numbers suffering from depression or anxiety.

All of this makes a strong case for putting mental health and wellbeing at the very centre of the agenda for London’s decision makers, whether the Mayor, local authorities, major employers or health care commissioners and providers.   Our view, however, is that, with some honourable exceptions, there is insufficient priority or interest given to the crucial importance of improving the capital’s mental health.  That’s why as a group of mental health providers we believe we need to work together to champion this issue and help mental health in London have a bigger voice.

As a group, we have set out three ambitions.  First to press for a reduction in the treatment gap for Londoners with mental health problems. Over 900,000 Londoners of working age are likely to experience depression or anxiety yet as many as three quarters of those individuals will fail to get any treatment at all.  The equivalent figure for diabetes is 8%.  Similar stories can be told for many other groups with mental health problems. Despite the rhetoric and some growing political commitment we have an enormous way still to go to deliver anything approximating to parity of esteem between physical and mental health.

Our second ambition is to help make London the most mental health friendly workplace in the world.  Many London employers, including those such as Legal and General operating in the pressured environment of the City, are already recognising this and taking positive initiatives to support employees with mental health problems.  Such employers see mental health friendly policies as offering a competitive advantage in the labour market and many others would benefit by following their example.  There is a role for the Mayor to champion this issue on behalf of London and to work with us and other organisations in London to promote good practice across employers including the public sector and small and medium sized employers.

Our third ambition relates to support the mental health and wellbeing of young people.  50% of adult mental health problems present before the age of 14 and childhood difficulties.  There are many good examples of services children and young peoples’ services in London but there is more to be done to ensure consistency of outcomes across the capital and to ensure a completely integrated approach between the NHS, social services and education.  There is no better investment in the future health and wellbeing of Londoners.

Our final in setting up the group is to stress the opportunity to build on what is already good in London’s mental health provision.  There are gaps to address but the story of London’s mental health is not solely one of deficits.  London already has many outstanding and innovative services and is one of the leading centres for research and education on mental health with organisations such as my own and others which are recognised across the world.

At times mental health has seen itself as Cinderella, the poor relation never invited to the party.  The Cavendish Square Group believes that those times need to change and that London has much to benefit from putting mental health and wellbeing at the centre of its agenda.  Furthermore if the time to come to the ball has come, a decent frock would also help.

Do the small things – St David’s advice for the NHS

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As a Welshman I am proud that we are the only one of the home nations which has managed to produce our own patron saint.  But what do we actually know of the life of Saint David (or Dewi Sant as we call him in Welsh)?

Dewi was a teacher and preacher living in the 6th century.  From West Wales by origins, he ended life as a bishop and was responsible for founding a number of churches and monastic communities across Wales including the one which now bears his name at St David’s.

Dewi came from the ascetic tradition in Welsh life. His monastic code made few allowances for creature comforts, stating that monks should pull the plough themselves without the use of draught animals, should only eat bread with salt and herbs and should spend their evenings in prayer, reading and writing.  He would have made an excellent defence coach for the Welsh rugby team!

According to tradition one of his maxims was “Do the little things in life” (Gwnewch y pethau bychain mewn bywyd). I have always been struck by this sentiment and believe it has a lot to offer in informing the task of improving health and care.

Much is talked about the need for transformation in our health and social care system and the scale of challenges around finance and affordability point to the need for some major changes in how we do things.  However I would argue strongly that the little things should also be central to our focus. Why?

There are a number of reasons.

First because the small things really matter in healthcare. Whether it is relation to the administration of medication, or the taking of a mental health history, small errors in healthcare can literally be life threatening. That responsibility for getting small things consistently right is one the things which makes clinical practice intrinsically challenging and stressful.

The better we get at getting small things right the better our outcomes will be and it should be a key priority for those of us in leadership positions in the NHS to do as much as we can to enable clinical staff to get those small but crucial things right.  As other industries have demonstrated very clearly, IT and real time decision support could have a big role to play in this respect. There is also room for psychologically informed interventions which help clinical staff to disengage from the stress of their roles and reflect constructively on their performance and the care they are giving patients.

The small things are also often the things which matter most to patients and their families.  While we welcome the miracles which can be offered by modern medicine in terms of life saving or life enhancing interventions, we also want to be treated with dignity and compassion when we are unwell and when we are in need of care.  Both of these are not single entities.  They are product of many small acts of welcome, kindness and consideration which repeated consistently reflect the values with which we want to deliver and receive care.

Small things in this way can be representative of bigger attitudes. Nothing better illustrates this point than Kate Granger’s inspiring “#Hellomynameis” campaign. As Kate movingly describes from own experience what chance have we of delivering compassionate care if we cannot take the trouble to introduce ourselves and explain what our role is in providing care. A small act but so symbolic of the value base on which care is built.

Recently when attending A&E with my disabled brother I was struck by the gesture of providing patients and their family with tea and refreshments while they were waiting.  In that instance my brother’s care (fortunately nothing serious in the end) breached the 4 hour wait but the cup of tea was a small and crucial gesture to show that the hospital recognised the value of our time as well as theirs.

Finally the small things matter because that is where we can do best in harnessing the contribution of front line staff for service improvement.  Staff can be justified in holding a sense of cynicism about endless transformation programmes and organisational restructures given the track record that these initiatives have across many parts of the health and social care system.  We need to make sure that these false dawns are not a barrier to engaging staff in making practical improvements in the immediate environment of car where their actions can make a difference.  We should give front line staff the space, tools and responsibility to drive improvements and, while recognising the complexity of the  systems we operate in, we should maximise the scope for local decision making which enables improvements to be implemented and sustained.

This should be mainstream activity but there is no doubt that as systems get put under greater strain and the focus of senior management is constantly directed to firefighting then the capacity of organisations to have an organic focus on improvement is diminished.

So in healthcare St David is right. The small things do matter. And while the challenge of some of the big changes we are going to have to make over the next decade in the delivery of health and social care can appear very daunting the world will always be better a place if we do the small things well.

The end of the Roman Empire has lessons for modern Europe

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476AD was a big year in the history of Europe, marking as it did the final end of the Western Roman Empire.  Edward Gibbon, the 18th century author of the magisterial Decline and Fall of the Roman Empire, thought it was down to the influence of Christianity on the Roman state.  Other more recent commentators have put it down to lead piping and the deleterious impact that would have on the mental capacity of the Roman leadership.  Whichever way it happened, it remains one of the seminal events of western history.

I was lucky to have been able to study this period at University and have recently reacquainted myself with some of the issues by reading The Fall of the Roman Empire by Peter Heather, Professor of Ancient History at King’s College, London.  For anyone interested I would really recommend this accessible and fascinating  account of these events.

The period is fascinating from a number of perspectives.  First because of the nature of the sources from which it is possible to reconstruct what happened.  It is a point in history where our view of events goes in and out of focus with great frequency.  At times we have very detailed information about what took place, drawing from historians and other contemporary sources.  At other times, particularly in the 5th century, the trace goes almost completely cold.  Some sources are only available to us by the chance of having been incorporated into later collections or in one case, being recycled with later works written on the back of earlier texts.  Archaeology, increasingly, has helped fill in some of the gaps and to broaden our perspective of the late Roman world by drawing in the day to day lives and transactions which do not make their natural way into the history books.

There is much need to thread different sources together, to make indirect connections  between sources, to judge not what is necessarily true but what is plausible.  This is a period where the historian needs also the skills of a Sherlock Holmes and it makes its study, as a result, a compelling intellectual puzzle.

But this is also a fascinating period because it entails one of the great discontinuities of western history.  Over a century between 375 and 475 one of the greatest military, political and administrative powers which Europe has known went from rude health to extinction.  For much of Romanised Europe, Britain included, this century marked the virtually total collapse not just of the Roman state but also of the systems of economic and political sophistication which that state had fostered.

That phenomenon is characterised by the fate of Roman London.  At the end of 4th century London was still a thriving metropolis, boosted by its role as a crucial link in the supply chain for the Roman army on the Rhine.  50 years later it was a ghost town.  The extensive use of coinage and literacy disappeared and while decline was not as rapid in all parts of Roman Britain as perhaps once historians thought much of what would have been thought as civilised life quickly vanished.  Even in Italy and the South of France where the impact of the end of the Empire was not so dramatic the world of the 470s was still radically different from that of a century before.

The third fascination is piecing together the reasons for the end of the empire, and in this seeing issues which are not unique to the Romans but resonate with the contemporary world.

The end of the Empire like many major historical events does not have one cause but is, rather, the consequence of different shocks and pressures coming together at the same time.  This was a period of major population movements with armed barbarian (their word not ours) communities, themselves under pressure from other groups further east, entering the empire and slowly establishing their own independent authority.

Just as importantly this was a state collapsing under the pressure of declining tax receipts and which could no longer afford the military muscle which preserved the pax romana which, in turn, supported the infrastructure on which Roman civilisation was based.

Thirdly this was a state bedevilled by periods of political instability.  In those times, even in the 5th century, when the empire was under strong leadership it made remarkable progress, despite declining military and other resources, in putting under check the pressures it was facing. Famously it was even able to defeat the Huns in 451 and 452 who had struck fear across the contemporary world.  At other times the state turned into itself in periods of infighting and instability, undermining fatally its ability to respond to external threats.

Finally like many historical events chance played its part.  A well organised attempt to recapture the provinces of Northern Africa in 440 had to be abandoned because at the point the Hunnic invasion was threatening the Eastern Empire.  If you are any good you can always manage a single problem but those who have to face multiple threats at the same time will often run out of luck at some point.

So what do these far off events tell us about Europe at the beginning of the 21st century?   We too live in challenging times with multiple external threats be they economic stagnation, climate change, extremism or regional conflict.  We face questions about the continuing affordability, in the wake of an ageing population and declining economic prosperity of the civilisation we created in Europe after the Second World War based on the principle of universal welfare.  We are dealing across Europe with a decline in public trust in political authority.

History swings between eras where millennialist interpretations of events abound and those which like the Europe of 1914 sleep walk into catastrophe.  Reacquainting myself with the history of the end of the Roman Empire is a chilling reminder of how the mighty can fall.  The threats facing us in modern Europe are also great and we cannot take for granted that the responses to them will be easy or necessarily successful. If we value the civilisation we have built and enjoy we have to be prepared to dig deep to save it.

Beds – there is a problem but the main solutions lie outside hospital

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No controversy rages more fiercely in healthcare, and in particular mental health care, than that of whether there are enough beds.   Although it is 20 years since the closure of the last long stay mental health hospital, the number of beds still holds significant sway as the working currency of psychiatric care.  The debate is a philosophical one as well as a practical one.  One side of the debate sees beds as the epitome of oppressive medically dominated care, in some cases arguing that with the right community resources there may be no need for beds at all, or at least not for what we currently define as psychiatric inpatient beds.  Others see the gradual erosion of inpatient beds as a big mistake and cites the undoubted pressure on resources in some parts of the country as proof of the urgent need for new capacity to be opened.

Pressure there undoubtedly is some parts of the country.  The routine use of out of area placements for non-specialist cases and the deplorable increase of the use of police stations as a place of safety are clear evidence of a system which is not working properly.  The Royal College of Psychiatrists has established an independent Commission under the chairmanship of Lord Nigel Crisp, former Chief Executive of the NHS, to look into the issues around the pressures on inpatient beds.

My own view rests in the middle of this debate.  I think there is clear evidence of an intolerable pressure in the system in some parts of the country, in part due to increased demand and in part reflecting cuts in services (not just in bed numbers).  I also think that it is unacceptable that patients in acute mental distress should have travel a long distance from home to access a routine inpatient beds.  However I do not believe that the answer is necessarily to open more beds although I would accept that in some places this may be necessary, at least in the short term.

So what are the answers?

First there is a question of the political and another commitment to ensure this issue is addressed.   This has to be a major a test for the principle of parity of esteem.  It is been interesting to see the effort which has been put in over the last couple of months to respond to  concerns about performance against the 4 hour wait target for A&E.  Why should there not be a similar level of interest to ensure that everyone in mental health crisis and who needs a bed or appropriate alternative gets one without having to travel out of area or ending up first in a police station?  The Crisis Concordat has been positive and helpful first step but why is the response to a broken leg transparently still more important than the response to a broken mind?

There is a big place for effective alternatives to admission.  Just as we are beginning to do in respect of physical health care we need to look clinically at the kind of intervention which is required in the community to keep people well supported and safe in the community.  While mental health has spawned a number of excellent specialist services such as Home Treatment teams , the unevenness across the country in the level of provision and, at times, a lack of integration with other community based provision whether in the form of primary care or community mental health teams can reduce their effectiveness.

Part of the response for me would to invest in short term community based residential alternatives such as the Recovery Houses which, as I know from my time at Rethink Mental Illness, voluntary sector providers are well placed to provide, working alongside Home Treatment Teams.  Such provision has the ability to provide an effective alternative to admission for many of the patients who would, historically, have been admitted as voluntary patients.

The third strand of action is around how we manage the existing inpatient provision.  The heart of this is to ensure that there is a clear therapeutic purpose for the admissions we make and the necessary provision to ensure the necessary resources exist to support recovery.  Benchmarking data demonstrates that inpatient units with greater capacity to provide psychological support for patients experience shorter lengths of stay.  Inpatient care cannot only be defined as place of last resort for patients who cannot be safely managed in the community.   We also need to focus on the support and welfare of staff and recognise that inpatient wards are amongst the hardest places we ask mental health professionals to work.

My final point relates to commissioning.  There is challenge here for local commissioners who have not always taken as full a sense of responsibility as they might for commissioning the right level of inpatient provision nor pushed providers as far as they could to ensure the provision available is of the best standard.  There is much good practice available in this area and accreditation schemes such as the Royal College of Psychiatrists AIM scheme or improvement initiatives such as Star Wards should be the norm for any commissioning worth its salt.

My other commissioning issue relates to secure care.  My answer to the beds conundrum is probably that we do need more local inpatient provision but, at the same time, fewer medium secure beds.  As I said at the time of Rethink Mental Illness’ Schizophrenia Commission report it is a scandal that we spend around 20% of the whole adult mental health budget on secure provision.   Much of the problem is a commissioning one and it is of no help that there is now a fault line between locally commissioned inpatient provision and nationally commissioned secure beds.

So in conclusion the pressure on acute mental health beds is indeed a major source of concern and a testament to how far we need to go to secure parity of esteem.  At the same time, as in physical care the major solutions to the problem lie outside the hospital and the success or otherwise with which we can join up the system of care which can intervene before people reach crisis point and intervene quickly and sympathetically if they do.

In praise of February

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Other months and seasons have a better press.  We celebrate the darling buds of May and the Season of mists and mellow fruitfulness but February has few plaudits.  February fill-dike is the most well-known epithet and, while probably not far off the mark, is hardly a flattering description. However, as an Aquarian, I feel I should leap to its defence.

I did n’t always see it that way.  As the only one of my family born in the winter I was always deeply envious of my brothers able to celebrate their birthdays in the middle of the summer.  But as I have got older I have increasingly appreciated the special qualities of the month, which while firmly of the winter, offers the first tastes of the return of sun and growth.

February is originally a Latin name relating to the Roman feast of purification Februa, held on 15th of the month.  This origin is reflected in the modern name for the month in many languages.  There are, however, some more graphic alternative names, for instance Solmanath (mud month) in Old English or helmikuu in Finnish meaning month of the pearl a reference to droplets of water which freeze on the trees and look like pearls of ice.

February is also distinguished by its shortness, always exaggerated for me by the fact that January often feels like a slow moving month after the bustle leading up to Christmas, and by the occurrence of an additional day every Leap Year.  I always feel sorry for people whose birthdays fall on 29th February although I am sure it can be used as an excuse for a very special party every four years.

February is the month of Shrove Tuesday and the start of Lent.  In our modern world it has hard to get our head round the difficulties of managing diet and the provision of food through the winter months.   While it has its religious and moral significance Lent also symbolises the struggle of subsistence communities to manage when fresh food is limited.  Those fresh foods, such as cabbages, which are available, are to be cherished.  That might account for another Old English name for the month or Kalemonath (cabbage month).

In the modern commercial calendar February is dominated by Valentine’s Day.  Maybe it is a sign of my age but the relentless advertising and commercial pressure has lost my affection for this festival altogether.  There is something, in my eyes, deeply unattractive about its saccharine portrayal of romantic love, linked to the psychology of collective guilt and I can find much better occasions to celebrate the relationships most special to me in my life.

A much better aspect of the month is the progress of the Six Nations Rugby Championship.  Not only does it provide excellent entertainment but it is one of the few occasions which celebrates in a positive and friendly way the traditional rivalries of this corner of the globe.  Its progress over 6 weeks also very clearly marks the passage from winter to spring.  The first weekend is often played in wintry conditions but by the time of the last weekend spring is usually definitely with us.

The heart of why I love February is that sense of contrast.  February can offer also sorts of wintry conditions: wind, rain, snow and ice but alongside them are hints that the world will not always be held in winter’s grip.

The light is the most obvious sign.  By the start of the month, even in the North, it is obvious that the oppressive sense of darkness of the depth of winter is coming to an end.  Journeys to work end if not start in the light and in the day the light has a brighter and more open quality which it lacked in January.  During the month the change of the seasons and the lengthening of the days gathers pace.

February is also the month of snowdrops and crocuses.  Those flowers which mark the return of life and growth and whose beauty is often as much a product of the incongruence of their setting in the otherwise lifeless earth.

I find the month a powerful metaphor for life.  In the hardest of times encouragement can sometimes be given by the smallest signs that things are changing for the better.  The signs which provide a permission for hope.   In darkest days those are things of much value and beauty like the first sight of a snowdrop or crocus in February.

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