Yesterday the First Annual Report of the Independent Mental Capacity Advocate (IMCA)  was published. I have had some experiences of using IMCAs over the last 18 months but with increasing frequency and it’s probably the same for most of my colleagues within the service I currently work in.

The role of the IMCA was created by the Mental Capacity Act to provide a statutory advocacy service to someone who lacks mental capacity when serious decisions are made. The referral to an IMCA is mandatory in two circumstances

- Where serious medical treatment is considered

- Where a move or change to long term accommodation

and it may be used

- in adult protection proceedings

- Care reviews

With the exception of Adult protection, the service is aimed at those without family or friends to provide this support or voice.

In our team we’ve made some use of the services available to us and built up some good working relationships with our IMCA service but some of the results are curious all the same.

To summarize very basically, the most common types of referrals seem to be regarding long term care placements - which is wholly unsurprising to me, at least, as that’s the most common reason that I’ve made referrals.

The report though states that referrals for serious medical treatment is lower than expected. Stating that

Six hundred and seventy five people were referred to the IMCA service for representation in relation to serious medical treatment in England during the year April 2007-March 2008. This is an average of four and half cases per PCT in a year – or one every three months

Rather damningly, the reasons proposed were as follows

i Some doctors do not understand that there is a statutory duty to make referrals. They perceive it as discretionary.
ii Some doctors do not agree with the statutory duty to make referrals. They choose to disregard it

With some IMCAs claiming that they were disregarded as some doctors felt that a non-medical person having input into a medical decision was ‘a waste of time’.  Clearly an area in which further awareness and input needs to be concentrated.

Most IMCAs were positive about the input that they were able to provide and sufficiently confident that it was a new service and something in addition to other advocacy services or social work services who might have an advocacy role but have other demands.

One of the interesting cases given, an IMCA explains that they were able to find distant family of an individual merely because they had had hours to be able to investigate and go back through notes - something a professional might not have  had time to be able to do.

Another exercise as a part of the review that the IMCAs were asked to do was to sum up their role. Many of them had been advocates prior to the new legislation and they claimed that the Mental Capacity Act had given them more power to ask questions on behalf of the people that they were advocating for - after all, their role is now legally entrenched. However they also claimed a powerlessness as ultimately their role is an advisory one and the decision-maker is still the decision-maker.

Personally I’ve found the IMCA reports provided to be useful for me to push my own commissioning and finance managers to provide care needed for an individual. In one situation, I discussed the recommendations that an IMCA made and it included the provision of a service that didn’t actually exist in our local authority - but by taking the report to our funding panel, I was able to point this out, markedly and explain that it was a poor reflection on our services that we were not able to meet the needs presented by an IMCA.

There are some interesting statistics at the end of the report which break down the referrals and decisions by month, need, decision type, ethnicity and finally a council-by-council breakdown of how many referrals were made.

I’m not sure if it’s the first time that an advocacy service has actually been created by legislation, I’d venture a guess that it is - but it won’t be the last time.

Indeed, the new Independent Mental Health Advocates created by the 2007 Mental Health Act can probably learn a great deal from the experiences of some of the IMCAs already in place.

One step at a time and moving, at least, in the right direction.

Arriving in a new country with little notice or planning can be disorientating at best. Although some of the language may be familiar through years of study, it’s different when you hit the ground running, so to speak.

And it isn’t just language that is confusing. People use terms you didn’t find in the outdated text books at school which taught you how to ask for directions but not how to ask for a doctor.

People you meet, sometimes friendly, sometimes curious, sometimes stubborn and sometimes actively aggressive. Calling home is sometimes a sweet relief but sometimes, especially when you have no plans, no job and are running out of money fast - it can be the culmination of built up disappointments - and a reminder to your family that you haven’t really worked things out yet or that things aren’t as ok as you thought they would be. And you don’t want people at home to worry.

Everyone knows it’s  hard adjusting to a new country, a new culture - but you knew you would be different.

But you weren’t.

It’s the simple things - not being able to say what you are thinking to anyone because mastery of the language is restricted to simple ideas. Will people think you are dim because you can’t say exactly what you are thinking in more complex terms?

People speak more quickly than your language instructor back home did. And they don’t pause for your mind to catch up.

On finding a job - it doesn’t always get better. People laugh at your accent, your word-finding difficulties. It’s amusing.

The frustration about not being able to communicate becomes stronger.

Which shops sell what things? Where do you go to post a letter? How do you access a doctor? What happens if you witness a crime?

All things you are familiar with at home become different - not just the language but the way of interacting. The ways that families work here - it’s just not the same. Men and women behave differently and not in the ways you are used to the gender roles at home.

Sometimes people are more open - sometimes more closed.

Sometimes you can feel more lonely than you have ever felt because although you have family, friends - they aren’t just.. well… there. You came and you need to stay.

You break a million new social conventions that you were never aware even existed and subject to more laughter, more joking - sometimes gentle ribbing, sometimes stronger.

Being aware of differences around you makes you far more aware of those people you had met at home - new immigrants, older immigrants - surrounded by different attitudes to those they had grown up around. Thrown into a different culture, different language, dialects, phrases that need to be learnt and put into context.

It’s get better you tell yourself. It can’t be that hard to adjust. And it does get better - after a few years - maybe.

-

But when you do go home, maybe after a year, or maybe two - there is nothing like those experiences to help you to understand what it’s like - what it could be like, to be in a different country, in a different state where nothing is quite like it was at home.

-

That’s what I was like for me anyway. I left the country seven years ago and came back again 5 years ago. It was the one of the best experiences I had - in retrospect - but at the time, well, it was exciting but also frightening. And lonely. Sometimes. I left not entirely sure if I was going to come back or not. In the end, I did. But when I go and see people who have moved here either through desperation or decision - I remember those days when I first arrived in my new country and think back to the feelings of exclusion which weren’t necessarily forced on me but that I felt at most turns and remember how even the most basic and seemingly obvious things become more challenging for me.

There’s one couple that I’ve been seeing quite a lot of over the past few weeks. He has dementia and his wife has depression. They have been co-dependent for many years - and probably would have continued to be until she became physically unwell quite suddenly which led to an intentional overdose and hospitalisation. This brought the matter to the attention of our team.

Anyway, things have been going quite smoothly under the circumstances but I’ve needed to spend a fair amount of time there. There is no family locally and we’ve put in some basic care but it has been accepted only with reluctance.

We have a fairly good relationship at this stage and are able to laugh and joke about things - but she is a generous soul and has taken to saving packets of crisps or putting biscuits aside for me. Well, apart from my weight (!) it doesn’t do much harm and although I’ve told her she needn’t (of course!) I know it’s going to be there.

Last week, the husband tried to put some moisturising lotion in my bag - ‘to keep my skin looking young and healthy’ - and although he told me happily that he’d got it for 49p at the local market, I didn’t want to start taking things from them!  We also have very strict guidelines about not accepting anything - which is fine because the last thing in the world I want is for people to be spending money on me!

I explained that I couldn’t accept the lotion although I appreciated the thought and that I could be sacked (ok, perhaps it was a bit dramatic but I did say it while laughing!) if I accepted presents and that I knew that because it was the same lotion she used, it would be much better if she kept it.

That just about held but it took a good 20 minutes to diffuse and convince.

Then, as we were chatting, I was talking about some of the ornaments in her home and how beautifully she’d paid attention to the decorating (which is true - she is extremely house-proud) and she began to insist I take those same ornaments home!

I smiled and explained that I think they look perfect where they are and that I wouldn’t want, wish or be able to take any gift from her but that I knew it was a generous offer which I appreciated greatly.

She smiled and continued with her offer.

I explained that I really neither wanted to nor was able to - that it wouldn’t be appropriate (and ensured that the smile and the tone were as gentle as possible - but increasingly forceful).

She continued, growing insistent - she could do forceful too!

I said that we have very strict guidelines about not being able to accept any gifts and that I knew that it was an offer made in a wonderful spirit but I would not be able to nor want to.. well, you get the idea.. it began to get a little repetitive.

And she continued, her husband entering the room to join in at this point.

I tried changing the subject - but it didn’t work for very long - her conversation returned to the ornaments that she was now determined she wanted to give me.

Trying to put light on the situation, I laughed and said that she was not to tempt me and emphasised again the policies we have at work and said, with a grin, that they would be much better enjoyed by her and her family.

She began to get increasingly annoyed with me.

I injected some more laughter - that usually helps.

She started to smile.

Phew, I thought, putting together my papers to leave as the conversation turned.

‘You will take them the next time though.’ she said ‘I haven’t forgotten’

Often, in the course of assessments, discussions, anything really, I try to use a conversational approach with the people that I work with - a part of building a therapeutic relationship - especially if there has been a lack of acceptance of assistance. And it isn’t false either. I’m generally a chatty person. If I enter a room full of strangers and no-one is talking to each other, I will often initiate random conversations. I like talking.

This is quite hard if the conversation only travels in one direction so obviously questions are asked of me - especially as I get to know people and families better.

I sometimes struggle with how much to share of myself.

Generally, I am happy to respond to questions I’m asked within reason. I’ll tell people if they ask something that for some reason I don’t want to answer - and the reason too. Of the questions I don’t answer are ones that I think might distract or lead a conversation in a direction I don’t necessarily want it to go.

I personally think its important to be honest but equally I don’t want to become the focus of attention during a conversation or to distract from the issue at hand.

On the other hand, it is useful on both sides if there is an ability to relate.  A part of me holds on to that person-centred notion that if I am expecting someone to answer a ream of often very personal questions themselves, it is unfair for me not to be prepared to answer some of them myself - so I can be seen not as a machine but as a person.

I do sometimes throw an anecdote or two in if I think it’ll relieve some tension - indeed, my lost holiday story (*sob* I should be in Italy now) caused no small amount of mirth just yesterday…   (to cut a long story etc, I booked a holiday to Venice a while back for this week - packed at the weekend and realised I’d lost my passport and didn’t have time to get another one so holiday was cancelled - excuse current grumpiness!).

I know other people I work with have different views - and there isn’t a right or wrong as far as I see it - beyond attention to personal safety and not distracting the focus of the visits and conversation.

I see a need to build relationships and there needs to be a two-way dynamic at least at some level - it’s just a matter of where the boundaries are.

It’s not a line I can draw easily in a proverbial sand but I think that a part of it is gut feeling and instinct.

And in the end, I can’t think of any occasions (although I don’t doubt that it might have happened) where I have said something that I later regretted.

There seems many an implied or direct criticism of being ‘overly political correct’ - people find some random and strange judgement and laughingly refer to ‘political correctness gone mad’ amid the sniggers with many of the facts being wholly absent.

The Daily Mail (there’s a surprise) gives some examples of how ‘far’ politically correctness can go - thereby diminishing it’s worth

Police in Cornwall told a witness they could not use the phrase “gypsy skirt”to describe the long floating skirt that someone involved in an incident had been wearing and instead insisted that it had to be referred to as a “traveller skirt”.

Staff on a training course were told that if a colleague said that he was going for a ‘quick half’, for some ‘amber nectar’ or for a ’swift bevvy’ he could well be an alcoholic

The signs on the Mersey Tunnel were changed from Manned and Unmanned to Staffed and Unstaffed in case they upset women.

MP Philip Davies in his maiden speech to Parliament said: ‘Whoever said ‘the customer is always right’ never worked for Asda. I encountered the customer who accused Asda of being racist towards Irish people because we sold “thick Irish sausages”. Trying to persuade her that “thick” related to the sausages and not to the Irish was beyond me.’

Just a few of the examples provided in the article - and for the record, I can see the element of offence in each of those examples - in the last example, it is more about making a mockery of those who are offended which is absolutely needless and further reinforces the point.

Sidelong at Flickr

I’m all for clarity of speech but I think we can find many many more examples where language does offend more openly - this article that was published in the Times at the weekend, for example, which goes back to the recent survey about mental health among MPs and explains the current position in, what I’d consider to be unnecessary terms, saying

Ministers are preparing to allow people labelled “idiots” and “lunatics” by archaic laws to stand for parliament.

Though it may come as a surprise to voters, laws dating back to Elizabethan times bar this category of people from becoming MPs.

Idiots are defined as those “incapable of gaining reason” and lunatics as people only “capable of periods of lucidity”.

The rules ban lunatics from standing as MPs in “their non lucid intervals”. They also ban anyone sectioned under the Mental Health Act from standing for parliament, even if they have made a recovery.

I mean would it really have been so difficult to write up the article without needing to refer to idiots and lunatics?

Couldn’t the journalist just have written a straight piece about the move for change? OK, it might not have been so ‘funny’ but if you look at the comments under the article, most seem to be jumping to the bait and saying that ‘the MPs are all mad anyway - see what laws they pass’.

Personally I think it’s an irresponsible trivialisation but it indicates the importance of language.

Political Correctness has been demonised. Wrongly in  my opinion. Language has enormous power to influence our thoughts and our attitudes. Lack of thought of the implications of language indicates a lack of respect to those who might find offence.

Yes, we can all find ’silly’ examples because any rule administered blankly will have exceptions - just as any law will - but to diminish the good work done in changing discourse and language by emphasising the ridiculous panders, I believe to a right wing agenda.

It’s interesting that one of the first links I found relating to ‘political correctness gone mad’ and ‘anti-political correctness’ had a large ‘Vote BNP’ (British National Party)  banner on the site - and is an apologist site for far right racist politics (I think the reasons for me not linking are obvious!).

It’s interesting how language has been turned into a part of the battle between right and left and making the politically correct debate seem trivial and unnecessary puts power back in the hands of the dangerously far right.

So political correctness is about more than changing nursery rhymes from ‘Baa Baa Black Sheep’ to ‘Baa Baa Rainbow Sheep’ so as not to cause offence and giggling at those ’silly’ enough to find offence in mere language.

It is providing political debate with a discourse about the use of language to offend and making assumptions about the language we  have always used without thought of the implication.

More power to the politically correct, I say - in a desperate bid to reclaim it as a positive rather than a pejorative term.

Community Care reports on a proposal by the Crown Prosecution Service (CPS) to recommend more severe sentences to those who commit crimes against older people

The policy is the last to be published on six “equality strands” and brings victimisation due to ageism in line with crimes driven by racism, homophobia, religious hate, disability hate and domestic violence.

Royal Courts of Justice

To be honest, before severe sentences are considered, I’d like to see the CPS take more action about taking seriously crimes reported by elderly people so that -any- sentence is considered.

I can personally run through many examples of protective conferences and planning meetings I’ve been party to that have whimpered to unsatisfactory endings because witnesses/victims were deemed to be unreliable witnesses in a court setting or not able to testify in a court - situations where I honestly think video-links would have been extremely helpful.

The policies currently have no teeth and as a victim’s daughter told me just earlier this week ‘why should it be that it’s my mother that has to move away from her home because of my brother’s actions?’.

No answer - but the CPS won’t take any action because of the unreliability of evidence, an injunction requires a similar level of proof and we need to ensure safety as best we can and unfortunately that means a move of someone who would in any other circumstance, be able to stay in her own home.

These are the things that constantly frustrate working in adult protection. The mechanisms just don’t exist to put into place and sturdy protective actions if the witnesses are never deemed to be reliable due to cognitive impairments. While allowances can be made for young witnesses, they rarely are for older ones.

This article explains

The policy also describes how older people who are acting as witnesses can be subject to “special measures” such as being able to give evidence by video link. Older victims will also be offered specialist advocacy services.

Seems well overdue but I’ll try not to be ungracious about it and merely add the sooner the better..

Action on Elder Abuse responded to this by adding

“There is a growing body of evidence indicating the extent and complexity of elder abuse, and the argument is becoming increasingly compelling for there to be equal parity with child protection and domestic violence strategies.”

Couldn’t have put it better myself..

Earlier in the week, I popped in to see someone that I hadn’t seen for a couple of weeks. I had intended it to be a fairly quick visit. Things had been stable and I was in the area so just wanted to check and show my face - just in case. I’d phoned the previous day and confirmed with her and her son that I’d be around.

Sometimes, I find a need to be proactive - rather than waiting for people to come with problems. Perhaps it’s more common with older people but people sometimes ‘don’t want to bother me’ with some of the difficulties they face so occasionally I have be quite determined to seek out these difficulties.

This was one such instance.

On arriving at Mrs S she told me that her son and carer had been taken to hospital that morning. She didn’t know how he was or what it was about except that he was in great pain. She hadn’t wanted to phone to tell me because she didn’t want to bother me!

A few phone calls later we had established that he was fine but also not fine in that he was going to be staying in hospital at least for a few days.

And that’s where we had to kick into quite speedy action -

- Call to district nurses to ensure they could monitor medication

- Informing care agency and asking for additional hours with as soon as possible effect (they were able to do the next day - which was enormously helpful!).

- call to other son who lived a little further away and ask if he can fill gaps for the immediate

- call to day centre to ask if they could increase service for the next few days to ensure hot meals

All the standard stuff, all fairly smooth.

The main difficulty though remained, at least for Mrs S.

Her son had bought her a wonderful TV. It had a satellite box, full cinematic experience, surround sound - along with various other bits and pieces that I couldn’t identify but somehow provided access to more television channels than there are grains of sugar in a sugar cube!

andyrob - flickr

And.. .4 different remote controls.

In between my telephone calls, Mrs S looked at me sadly and asked me if I could turn the television on for her.

‘I haven’t been able to watch the telly all day’ she said

‘I can’t work out which control to use’.

I looked in askance at the pile of controls

‘I’m not afraid of buttons’ I said to myself.

We combated PIN numbers (hurrah for defaults!)  and some juggling of remotes to find the something she recognised.

Brief explanations and an extremely poorly drawn chart, along with some sticky tape and highlighter pens allowed me to ensure she knew at least, the right volume buttons and how to change the channels.

But this is the kind of thing you possibly don’t think of when you buy your mum the latest digital TV surround sound cinematic experience television - and she just wants to see Emmerdale.

I did think though, as I left her happily watching - that I was really glad I had decided just to pop in that day of all days - I would have found out the next day anyway, when her regular carer showed up but one day without television - I don’t know if I’d be able to manage it!

Getting satisfaction from a job is an important factor of any career decision and ‘wanting to help people’ is an oft-quoted reason for wishing to enter the general ’social care’ arena. All good things - but this isn’t altruism. Not as far as I’m concerned. I am being paid for my job and to have a job that is satisfying and interesting is a lot more than some people have.

(wanting to help.. )

I read an article called ‘Do you need to be needed?’ by Carol O’Dell on Mothering Mother and More a while ago and  I was drawn back to it recently. It talks about the need of the carer, professional or not, to be needed and what gaps the position of caring might be filling in that person’s life.

It’s something we spoke about with a fair amount of regularity when I was doing my initial social work training and it’s a thought that has flitted in and out of my mind ever since.

Looking around the people with whom I trained - there were a few who had been users of services, some with good social workers who they wanted to emulate, some with horrible experiences of social workers which they wanted to combat from within and prevent others having the same experience that they had  had.

Some were completely oblivious to what social workers actually did on a day-to-day level and just kind of stumbled into it.

Others had family members who were social workers so just as there are families of lawyers and doctors, they were doing what their mother, or sister had done before them (among the people I know, it’s always female family members -  it could well work the other way round!).

I think there is an inherent ‘need to be needed’ though. By running around dealing with other people’s problems, how much are you able to avoid dealing with your own?

It’s something I’ve thought about and considered for a while.

I am aware that I gain some kind of personal satisfaction from working in a ‘helping’ profession and I hope that by acknowledging that, and reflecting on it, it is allowing me to focus on the needs of those for whom I work, rather than my own needs.

But it would not be honest to pretend that those needs do not exist. It is a basic human condition to want to be liked or wanted or needed, perhaps respected. Without acknowledging what I am gaining personally through my role, I am not being honest in my undertaking of it.

Reflection is used a lot in practice learning and extensively in post-qualifying training. Where I thought at times, it was a bit vague, ’soul through a lens’ stuff, I can see that it is the best way of keeping yourself in check through the work that you do. As a result I think reflective practice and constant and consistent reflections on motivations is one of the most valuable skills I learnt through my training - particularly since qualifying.

If I am aware of my own weaknesses and prejudices, I am much better able to nullify and combat them in my working practice.

And to quote Confucius

By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest.

So really, as there is nothing new here. It just takes a while to come round to it although accepting that  I am helping myself through my work - but I would honestly hope that this is never at the expense of those for whom I am paid to help.

More than a quarter of parliamentary staff surveyed, including MPs, Lords and support staff, suffer from mental illness brought about by stress according to an article published in The Independent today.

A MIND press release further breaks down the figures revealing that

An anonymous questionnaire completed by 94 MPs, 100 Lords and 151 parliamentary staff has revealed that:

• - 27% had personal experience of a mental health problem including 19% of MPs, 17% of Peers, 45% of staff
• - 94% had family or friends who have experienced a mental health problem
• - 86% of MPs said their job was stressful
• - 1 in 3 said work-based stigma and the expectation of a hostile reaction from the media and public prevented them from being open about mental health issues.
• dlade at Flickr

So in effect, they are no different from any of us really. Except arguably they have a more stressful job that draws them into the limelight.

Both the article and the report though, highlight the additional stigma that exists regarding mental illness in the sense that even policy makers are not able to admit to it openly for fear of harming their careers.

Currently the Mental Health Act (1983) bars an MP from re-election if they are admitted to hospital under compulsion - and MIND highlights the discrepancy between the treatment of a someone who has recovered from a physical illness with someone who has recovered from a mental illness by stating that

… if an MP is physically incapable of working for six months due to a serious illness they would not be forced to stand down. The majority of MPs who responded thought this rule was discriminatory and urgently needs to be changed.

Without wanting to be too harsh, there does seem to be something a little ironic about MPs calling for the law to be changed.. especially as a new amended Mental Health Bill has not long passed through their hands.

The Independent quotes one unnamed MP who insisted on anonymity as saying

“I would love as an established MP to talk openly of the serious depressive illness I endured long before I became or even thought of being a MP.

“It might serve as some small encouragement to those few young people currently shrouded in despair, feeling their life is hopeless. I have no confidence though that national or, importantly, local media will not succumb to the temptation in their coverage to make life more difficult for my party.”

I would also love you to, anonymous!

It should be something that absolutely works in a positive way to lead the way for others who are experiencing difficulties or seeing the difficulties that family members are experiencing to show what is achievable and the potential to increase public understanding and awareness could be immense.

Concern about career is a major obstacle to a wider openness about mental illness and any widespread attempts to further batten down the stigma that is so often associated with it.

Totalblue writing yesterday referred yesterday to  an article which highlights the difficulties of workplace prejudice relating to mental illness suffers by those in The City.

Of course, this comes as no great surprise. The figures suggest though, that a lot more people suffer from mental illness than are able to speak about it - which indicates the excessive levels of stigma that exist. It seems to be something like the proverbial elephant in the room that no-one wants to talk about.

I certainly don’t exclude members of my own profession either. A good friend of mine - also a social worker - was suffering from depression  (and quite severe)  and tried to insist  her doctor signed her off with ’stress-related’ unspecified illnesses because she was terrified that it would forever mark her career.

Figures suggest almost everyone is affected, if not personally, then a family member, close friend. I would wager a bet those journalists in the national and local papers that the MPs are concerned about are affected and certainly the constituents that vote for them, everyone.

It just needs a few more to be open and of course, who is in a better position to change discriminatory laws than the MPs themselves!

The question of ‘normality’ and what it is  has cropped up again in relation to this weekend’s Bonkerfest. I read about it in The Times at the weekend in an article which explains the ‘Mad Pride’ movement which has made its way over here, unsurprisingly, from the States.

The Times article refers to the growing movement of people who initially in the States but increasingly here

‘are gathering to fight the stigma of “the mad woman in the attic” and show they can live successful lives.’

Liz Spikol , a US journalist with a diagnosis of bipolar disorder, is seen as a torch-bearer for the movement which is growing - and her blog is one of the keystones of the movement. It is and has been spreading though.

The Times announces that

In London, a group of people who self-consciously refer to themselves as “mad” are getting together for a day-long festival on Saturday, aptly named Bonkersfest. It bills itself as a celebration of madness, creativity, individuality and eccentricity, “bonkers celebrations for everyone — bonkers or not”.

So Dolly Sen, 37, an artist and writer, will spend the day trying to screw a light bulb into the sky because “the world is dark enough as it is”. There will also be a moving padded cell, a de-normalisation programme, and performance art by Bobby Baker featuring seven adults dressed as frozen peas.

I have to say the adults dressed as frozen peas actually sounds  interesting!

It certainly seems like there could be a lot of fun to be had on the day.

Bonkersfest is organised by Creative Routes who say

This year’s theme of ‘De-normalisation’ sets the physical staging of the festival into zones of perceived ‘normality’ which get madder, sillier and more intense as they go! Festival-goers will experiences their own understanding of the mad reality via a sensory, colourful kaleidoscope of environment, image and sound. In addition to live art and visual installations, BF08 will host the Big Top outdoor music stage and the Red Star will host The Muses Café, a mad programme of theatre, poetry and performance.

The theme being ‘de-normalisation’ makes you challenge what you regard as normal.

I  like having assumptions challenged - and I think that a new way of communicating and distributing information has been borne with the growth of ‘new media’ sources.

Anyone can start writing and an audience can and does follow. Self-expression and creativity are, I think things that can often promote positive mental health for those both for those who have diagnoses and those who don’t.

I’ve always felt that definitions and diagnoses can sometimes be about thin lines drawn arbitrarily in the sand on the basis of risk.

Eccentricity has a general acceptance in our culture but when it becomes ‘madness’ it becomes unacceptable? Society makes decisions about where the lines are drawn sometimes. What is an acceptable idiosyncrasy and what is risky behaviour?

There’s no answer really. Sometimes the side of the line on which we stand depends on who the person is that is judging and where there own experiences, prejudices and attitudes have taken them.. but sometimes it is not.

To be honest, I’d never really thought about equating sanity with normality. I think everyone experiences differing mental states to some extent through their own lives but society - or rather Western societies like to classify.

You are one thing - or the other

You are good - or bad

You are sane - or insane

You are black - or white

An optimist or a pessimist.

You are normal - or unusual.

Self-expression but also self-definition are the keys to maintaining identity and the peak of self-actualisation at the tip of Maslow’s hierarchy of needs.

The difficulties come though if people start to either self-diagnose or associate mental illness with being creative necessarily or being ‘cool’. It isn’t. Accepting what you are is one thing but trying to ‘fit in’ is something different.