Level Headed Questions about Identity

individual

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INTERPERSONAL : SCIENCES             

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL   

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group

Individual - Person IDENTITY  Personality Character Traits   Spiritual identity   Religious identity brain in a vat  thought experiment    SPIRIT level	'LEVEL HEAD'
Social identity (cohesion) Collective & Cultural identity   Role & Family identity   Relational identity Languages media(-ted) identities	Local / Regional identity National identity: North-South :: West-East divide Organisational / Inst. identity Political   GLOBAL NORTH:SOUTH

The Legend of St Edmund and the Wolf

Source: 'The Bay Horse' local pub and Coffee House.

Previously: 'identity' : 'philosophy' : 'alcohol' : 'South' : 'language'

HIFA Discussion: Alcohol Use Disorders - Drink Aware and Change

Dear HIFA colleagues,

I would like to invite you to retweet the following that I have just sent on our X/Twitter account:

"Pls RT: I just took the DrinkAware test as if I drank 3 pints a day (well over the recommended limit). The result was "Great news! You are at lower risk of alcohol-related problems". We invite others to check. Thx NPW https://www.drinkaware.co.uk/tools/drinking-check#/ "

You can see the tweet and retweet here: https://twitter.com/hifa_org/status/1762399130154885617

We are unsure why the test - which is taken by 900 people every day - is providing such misinformation.

DrinkAware is funded by the alcohol industry.

Thank you for your help to publicise this issue.

Best wishes, Neil

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil AT hifa.org

To which I replied:

RT'd as requested.. 

Reply from twitter ... 

This evergreen article was written 10 years ago
"Be aware of @Drinkaware "https://t.co/UGcVFb5gFB via @peter_g_miller et al

— Ash Paul (@pash22) February 27, 2024

McCambridge J, Kypri K, Miller P, Hawkins B, Hastings G. Be aware of Drinkaware. Addiction. 2014 Apr;109(4):519-24. doi: 10.1111/add.12356. Epub 2013 Oct 28. PMID: 24164565; PMCID: PMC3992896.

UPDATE 10th March

Dear HIFA colleagues,

Further to our discussions on HIFA, in the past week DrinkAware HAS CHANGED THEIR ADVICE to people who drink 42 units per week (3X the recommended maximum). Questions remain about how many people were misled by previous advice, whether that advice was deliberate, and whether WHO's AUDIT test (currently used as the basis for the DrinkAware test) should continue to be used by anyone as an unsupervised self-evaluation tool.

BACKGROUND On 22 February 2024 I reported on HIFA an apparent problem with DrinkAware, the UK's largest alcohol charity, funded by the alcohol industry. https://www.hifa.org/dgroups-rss/alcohol-use-disorders-79-role-alcohol-industry-10-alcohol-industry-and-misinformation

I took their Drinking Check. I posed as a man who drinks 42 units per week (3X the recommended maximum) and DrinkAware told me: "Great news! You are at lower risk of alcohol-related problems. This means you are at lower risk of serious diseases such as stroke, heart and liver disease, and seven types of cancer and may already be noticing the benefits of lower risk drinking such as deeper sleep, more energy and brighter moods."

There was no advice to reduce my consumption.

This test was repeated by other HIFA members in subsequent days, with the same results.

On 4 March 2024 we reported our findings to the World Health Organization.

CHANGE IN ADVICE Today, 10 March 2024, I took the test again. As before I posed as a man who drinks 42 units per week. This time I got a different result:

"You are on the right track. You are at lower risk of alcohol-related problems... To keep your health risks low, the UK Chief Medical Officers advice is to drink no more than 14 units a week. If you are regularly drinking above 14 units per week there are tips and advice below about how to cut down."

INTERPRETATION Prior to 4 March 2024, DrinkAware was encouraging many heavy drinkers (up to 42 units per week) to continue drinking as they are.

DrinkAware claims that its Drinking Check tool was used by 250,991 people in 2021, so it appears that potentially tens or even hundreds of thousands of people drinking 14-42 units per week may have been misinformed.

At some point between 4 March and 9 March, Drinkaware changed their Drinking Check tool so that heavy drinkers (up to 42 units per week) are now advised to cut down.

SHOULD WHO's AUDIT TEST BE USED AS AN UNSUPERVISED SELF-EVALUATION TOOL?

Previous messages on HIFA have suggested that AUDIT should only be used as a clinical tool by health professionals, and not as an unsupervised self-evaluation tool. WHO's AUDIT manual notes: 'Care must be taken to tell patients why questions about alcohol use are being asked and to provide information they need to make appropriate responses. A decision must be made whether to administer the AUDIT orally or as a written, self-report questionnaire.' https://iris.who.int/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a-eng.pdf

NEXT STEPS

How many people were misled by previous advice, was that advice deliberate, and should WHO's AUDIT test (currently used as the basis for the DrinkAware test) continue to be made available as an unsupervised self-evaluation tool?

I invite HIFA members to suggest next steps. Are you a health journalist (or do you know a health journalist) who might be interested to look into this in more depth? Please pass this on and/or contact me: neil@hifa.org

Meanwhile I shall report this new finding to WHO.

I look forward to your comments and suggestions: hifa AT hifaforums.org

Best wishes, Neil

Finally ...

Dear HIFA colleagues,

We now enter our 6th and final week of the deep-dive into Alcohol Use Disorders, where I invite you to reflect on what has been discussed so far (and what has not been discussed). In your view, what is the key learning in relation to the 5 questions we have explored:

1. Do people understand the health, socio-economic and environmental harms of alcohol? What matters to them? How can they be better informed? How to reduce stigma? 2. Do health workers have adequate knowledge to prevent and manage alcohol use disorders among their patients? What matters to them? How can they be better informed? 3. What is the role of the alcohol industry? What can be done to address misinformation from the alcohol industry? 4. Do public health professionals and policymakers have adequate knowledge to prevent and treat alcohol use disorders in their country? What are current national policies and what more can be done to fully implement those policies? 5. How can we define and measure alcohol use disorders?

To help with this, I have prepared a full compilation of our discussion so far (205 pages):

https://www.hifa.org/sites/default/files/publications_pdf/Alcohol_Use_Disorders_Compilation2.pdf

I shall now work on an edited version (selected text organised under subheadings for each of the 5 questions and for other topics) and will get this to you asap.

Many thanks, Neil

HIFA Discussion: Alcohol Use Disorders - Do people understand the harms of alcohol?

Dear All (with further editing since posting)

The discussion, points, angles, questions ... are coming thick and fast it is difficult to keep up.

Many thanks for the summaries; and of course the discussion which archived also acts as a resource - repository:

https://www.hifa.org/news/hifa-announces-deep-dive-discussion-alcohol-use-disorders-starts-5-february-2024

I wonder whether the question: 

"Do people understand the harms of alcohol?" must always be placed in context?

It is radically different when asked of the tee-total, dry, safe drinker; and someone (still) actually in their alcohol drinking?

It occurs to me that alcohol, even more so than 'other' substance misuse (heroin...) represents what must be *the* contradiction, paradox in healthcare - except the tragic loss that is suicide.

Contrast substance misuse inc. alcohol, with 'help-seeking' and 'The Sick role'

https://www.england.nhs.uk/blog/ed-mitchell-2/

Plus, the (medical) sociology of the decision to consult/refer, and how in mental health (UK), the mental capacity act is apparently being misapplied ('policy-drift'?**):

https://www.lawsociety.org.uk/topics/blogs/are-mental-health-and-capacity-laws-at-risk-of-being-toxic

https://www.communitycare.co.uk/2017/08/23/flawed-use-mental-capacity-act-key-theme-safeguarding-adults-reviews-report-finds/

Individual
   |

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :   POLITICAL 

|

Group

	continental drift
	policy drift?

Previously, I highlighted how as a Community Psychiatric Nurse 1985-1995 (adult) .. if a patient/client was not working to control/reduce their alcohol consumption they may be 'counselled' re a pending discharge and referral back to their GP - family physician. In supervision with the team's manager they would want to know what is 'happening'. It being important not to create (social) dependency, or worse support someone in their alcohol misuse.

There was a sense, still is(?) that in substance misuse (across forms) - the individual has to reach 'rock-bottom', literally the 'gutter' that is the point they decide (really?)** to live, or carry on to suffer irreversible brain damage, or premature death. Regards the 'brain damage' it was a struggle for 45-60 minutes given the impact upon short-term memory, what time, .... is it indeed? When the patient was not living alone, how did the relative, family cope?

Is having to reach the gutter, the bottom, a trope/myth? In psychosis rather than assume the patient is beyond being reached prior to being medicated there are psycho-social interventions that can be commenced: being available / with. Here though this is usually 'first episode'. There is no analogue here, unless first admission to an in-patient unit is taken as a golden opportunity? But this also depends on its nature (funding, staffing - expertise), a general adult mental health ward, or specialist unit.

https://www.imdb.com/title/tt0048347/

What is the current strategy?

In terms of 'HIFA' - and the person that counts**, not only do they not have the 'information'; they do not have the EXISTENTIAL INFORMATION as it relates to them: 'Health Information for YOU'!

Again in Hodges' model we can contrast the dichotomy/polarisation of INDIVIDUAL :: GROUP.

The model's being situated; and able to encompass data, information, knowledge (facts, for example, and their delivery) - wisdom (Multi-contextual / transdisciplinary..).

I admire people who work in these services (learning disability and palliative care); as they must be severely tested as they retain an ability - the humanity - to 'see' the person whatever the patient's situation with their lack of awareness (capacity..?) and its critical salience.

Peter Jones
Community Mental Health Nurse and Researcher
Blogging at "Welcome to the QUAD"
http://hodges-model.blogspot.com/
http://twitter.com/h2cm
h2cmng at yahoo.co.uk

Location: It was just a cappuccino.

**Which points to the relevance of the POLITICAL care/knowledge domain in Hodges' model.

HIFA Discussion: Alcohol Use Disorders - Language 'being drunk'

----- Forwarded message -----
From: Peter Jones, UK <hifa AT hifaforums.org>
To: HIFA - Healthcare Information For All <hifa AT hifaforums.org>
Sent: Sunday, 25 February 2024 at 06:35:47 GMT
Subject: [hifa] Alcohol Use Disorders (86)

This morning on Times Radio UK, Hugo Rifkind 1000-1300 from 10.58:30 UTC:

 https://www.thetimes.co.uk/radio/show/20240224-26978/2024-02-24 

- there was mention of research in Germany on language, finding that there are over 540 words for 'drunkenness' being drunk. Apparently, the key is adding -ed to many words.

https://www.research-in-germany.org/idw-news/en_US/2024/2/2024-02-19__I_m_gonna_get_totally_and_utterly_X-ed.__OR__Can_you_really_use_any_English_word_to_mean__drunk__

This stood out for me as Hodges' model can potentially encompass the full corpus of a language, with the various contexts in which language is applied/used.

Significant of course informationally, in evidence-based practice, and research, were 'definition of terms' are (usually?) essential.

Also reminded of national variation in clinical/medical terminology. Scottish slang for injection includes 'jag'.

For health communication and HIFA, clearly language is fundamental and presents a real 'can of worms' (sorry!) in sense-making, creating 'noise' in the communication channels.

Should health services/systems effect a (gradual) change (shift) of emphasis to education and prevention - with the requisite policy support (utopic?) then this will need to be addressed.

In checking this news, it appears Germany has a more acute problem with alcohol. Can anyone 'local' - please shed any light on this?

I will post again about the HIFA discussion with a week ... left and highlight the above.

Many thanks

Peter Jones
Community Mental Health Nurse and Researcher
CMHT, Prescott House, Salford NW England, UK (Mon-Tues)
Blogging at "Welcome to the QUAD"
http://hodges-model.blogspot.com/
http://twitter.com/h2cm

h2cmuk AT yahoo.co.uk

HIFA Discussion: Alcohol Use Disorders (37) Do people understand the harms of alcohol? (9) How can they be better informed? (5)

Further to the post on 1st February 2024:

HIFA discussion on Alcohol Use Disorders, 5 Feb - 17 Mar 2024

- I have f/w some reflections (edited here). You may have your own experiences, skills, knowledge to contribute?

<>

As a teenager you were very aware of peer pressure (as a social expectation) to drink. Is it an acquired taste?

The media played a key role - advertising "Tetley Bitter-men", "Double Diamond - works wonders", Babycham, Advocaat, Martini Rosso .. and many of the popular TV series we consumed (pardon the pun).

Getting in the pub AND served was a right of passage - and a rather 'tame' one for a white, male.

In the family the harms and risks of alcohol were explained. 

Sometimes they were demonstrated at parties, weddings, the aunt, uncle - relative who was notorious for having too much.

Studying literature at school did have a role to play - although less directly.

Although on reflection when there were school assemblies I wonder if 'drink' (Church of England) was mentioned?
Interesting perhaps - the change in daily school routine.

I remember at a birthday party for a fellow class pupil at a social club, the birthday boy was sick all over the table - yes - had been drinking.

Tempered my attitude early on - c.15.

As a nursing asst. and student nurse you realised the other - dark - side. The key being the contradiction that alcohol represents:

• Drink to relax, socialise, be friendly, enjoy yourself;
• Impact of your health, risk of addiction, violence, (brewer's droop was an early lesson - tho not practically);
• IF YOU develop a drink problem then you're on your own and so is your family (there are of course agencies in developed nations - but the funding disparity - as in, gambling, tobacco?).

In a 'local' - public house - pub it was known in 1970s for some regulars (invariably men) to down c.12 (more?) pints in a night - even after drinking hours: they were heavy goods vehicle drivers.

---------
I may have posted before - how in 1987-88 I completed a study of alcohol (intervention) teams, Preston, Salford, Blackburn here in NW England. The consultant psychiatrist made a key point about the (much debated even then) use of economic levers to help reduce alcohol consumption.

Scotland have just updated their intervention:

https://www.theguardian.com/society/2024/feb/08/scotland-raises-minimum-alcohol-prices-by-almost-one-third

As a student nurse - I was already aware of some of the inorganic molecules that have been found in space: the original primordial soup!

The chemical names still remind me of a chemical plant, such as the former ICI plant at Widnes / Runcorn, Cheshire, England, e.g.:

https://thumbs.dreamstime.com/b/heavy-industry-panorama-night-panoramic-view-chemical-plant-refinery-blue-sky-illumination-some-freight-85481422.jpg

This in-turn takes me to the miracle that is the liver - the biological chemical plant - with a potential powerful message in how 'alcohol' is broken down:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527027/

Sometimes insight into this can work wonders in terms of motivation for change - the facts - not trying to scare (waste of time)...?

Which brings me to the obvious 'contradiction' in caring for people with a primary / secondary problem with alcohol.

Having a liver function test.

If it's OK that *means* I can carry on!!

I have over the years developed what imho I consider to be potentially therapeutic relationships with patients affected by alcohol.

I say potentially as I, with supervision, have had to withdraw input and discharge them. Even if the client can't 'draw the line', you cannot support the patient in their damaging alcohol consumption and related behaviours. The offer of further support was offered, with signposts should there be a change of  mind.

Alcohol, tobacco - vapes, the 'mental pollution' that can be passed as legitimate 'advertising', fake news ... still calls for a generic model, a universal conceptual framework for personal and global health - across literacies and forms of informatics:

'alcohol'
https://hodges-model.blogspot.com/search?q=alcohol

Just to close I saw an item (I will try to find...) on the preponderance of 'smoking' in films 1940s - present day.

Still a problem now.

Of course: advocacy for health requires constant vigilance.

HIFA discussion on Alcohol Use Disorders, 5 Feb - 17 Mar 2024

Dear all on HIFA,

It's just 4 days to go before the official launch of our deep-dive discussion on Alcohol Use Disorders, 5 February to 17 March 2024.

Please forward this message to your contacts and networks and invite them to join! www.hifa.org/joinhifa

More information here:
https://www.hifa.org/news/hifa-announces-deep-dive-discussion-alcohol-use-disorders-starts-5-february-2024

HIFA is grateful for sponsorship from the Ulrich and Ruth Frank Foundation for International Health known online as NextGenU.org.

Note: We have opportunities for further sponsored discussions in 2024. We have 20 working groups on standby to plan and implement a discussion [ https://www.hifa.org/projects ]. Or we can start a new group to address a topic that is important to you. Also new in 2024 there is the option to have live webinars to complement our forum discussions.

To discuss possibilities, please contact: neil AT hifa.org

With thanks, Neil

HIFA Partnerships and Projects working group: https://www.hifa.org/projects/partnerships-and-projects

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization.

Health information & 7th Global Alcohol Policy Conference

Politicians -
GIVE HEALTH LITERACY A CHANCE!

INDIVIDUAL

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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

cognitive access, basic literacy	'legibility', digital access
PUBLIC - MENTAL - HEALTH Society Communities Most vulnerable groups Digital divide	"Why are alcohol companies pushing for QR codes on labels? Well, which of these two labelling methods actually shows the risk of alcohol consumption, 1 or 2? QR codes are a way for producers to say they are informing consumers, without doing so." @InstAlcStud economic access Health Information For All POLICY 7th Global Alcohol Policy Conf. Alcohol Taxes - False economy?

My source: https://x.com/InstAlcStud/status/1703658612109742578?s=20

Court of Protection: Supported Decision-Making - case of P

SELF - individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group - POPULATION

Decisions on: residence, care, alcohol consumption, depression reluctant and distrustful of (statutory) services Who would P feel she could trust  to help with decision? psychological interventions P. being listened to ... feel safer, healthier, in control, respected	detox placement  (identified by LA) place - area physical health services Access to knowledge - local expert - 'signposting'
Asking why and why again ... distrust of social workers sister and neice primary people of trust then GP. So family and GP became more involved. engagement	Local Authority [LA] Social workers and mental health support workers agreed to take a back seat CRPD Committee Mental Capacity Act Judge, Lawyer option to introduce elements of supported decision-making into the Court of Protection

This morning in a Court of Protection case, Macdonald J endorsed a supported decision-making approach. P has alcohol dependence & depression. She lacks capacity to make decisions about residence, care and alcohol consumption. (1)

— Oliver Lewis (@DrOliverLewis) April 3, 2019

Health Communication: Noise in the Channel(s)*

"Despite overwhelming evidence that illnesses come in clusters with 

mental and physical 

components, we continue to present public health as a series of separate issues - 

"stop smoking", "lose weight", "drink less". 

This is confusing, disempowering and psychologically naive. 

The public has no idea what to prioritise and is prone to either write 

off illness as inevitable, or to feel inadequate and anxious, 

leading to further unhealthy behaviour.

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

People see mental illness as mysterious and frightening and ...	... physical illness as explicable and fixable.

Neither view encourages healthy lifestyles."

*still.
 
McCullough, A. (2009) Healthiness is all in the mind, Health Service Journal, 5 February, 119(6142):18.

[Also inc. "Planned investment in mental health promotion in adult mental health services in England in 2007-08 was £4m out of the total mental health spend of 4.5bn - less than 0.1 per cent." ]

Book: Sound - A Story of Hearing Lost and Found

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Sound	"Sight gives you the world, ...
... but hearing gives you other people."

Source: Holgate, A. The Sunday Times, Culture, Books, 28 May 2017. p.36.

Glen Campbell - I'm Not Gonna Miss You

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

Music video by Glen Campbell performing I'm Not Gonna Miss You. (C) 2014 Big Machine Records, LLC.

Glen Campbell and Jimmy Webb have produced some truly age-defining music. A memory I hope to cherish all my days of these tunes was September 17 1979 flying Wardair from Manchester to Calgary. We chased the sun all the way over Iceland, Greenland ... with Glen singing along. A magical experience and holiday.

Thanks Mr Campbell!

May the nursing care you now receive be as person-centered as your music is to me and countless other people; and may high quality care be available to all who need it.

Thanks to Randy Roberson for this news.

Alcohol: Messages in bottles, domains and anagrams

The perennial health news item that is alcohol has bubbled and overflowed this week. In 1987-88 I visited several nearby alcohol services in Blackburn, Preston and Salford with a questionnaire to compare and contrast with Chorley which at the time had no dedicated alcohol services. There was Alcoholics Anonymous AA and Al-Anon, but nothing specific through health beyond community psychiatric nurses. The project was for the CPN(Cert.).

Back then I remember a Consultant Psychiatrist saying that the level of alcohol consumption is directly related to cost. The literature I read also drew attention to historical comparisons. I think it was Alcohol Concern who supported this view and called for urgent action. Of course all that was some 24 years ago. Incredible that there is some movement in 2012. In 2007 the taxi driver from Elounda to Heraklion airport described the movement and horizontal stasis that adorns the pavements (and spills onto the roads) of Malia as we zipped by. The Brits do have a problem. A Consultant physician highlighted this from a hospital ward on BBC Radio 4 news today.

Don't get me wrong: I like an occasional drink but my enjoyment of alcohol has been tempered over the years by several experiences:

• An early party aged 15 (and at a church social club) preloading was already in vogue. No sooner were a group of us sat at a table than someone threw up on the table. It was alcohol.
• Biology and human biology lessons helped instil the impacts of alcohol.
• Having to say 'goodbye' to clients with a drink problem, duly referred by their GP. I cannot support them in their drinking after several attempts to effect change.
• Appreciating the link between drink and risk behaviours.
• Working with people whose 'ill-health career' has seen them having to live with, but not themselves recognise Korsakoff's syndrome.
• Seeing people over three decades who cannot be supported in the community with their family, relatively young for residential care, but given a lack of specialised facilities - there they frequently are.

Hopefully the policy turn will have a positive impact extending beyond news headlines:

Minimum alcohol price planned for England and Wales
http://www.bbc.co.uk/news/uk-17482035

Alcohol pricing: politics under the influence 
http://www.guardian.co.uk/commentisfree/2012/mar/23/alcohol-pricing-politics-under-influence?newsfeed=true

With the prospect of an alcohol and a new NHS information strategy in England you hope that some dots can be joined. Here are a few:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Motivation    Psychological effects Attitudes to risk         Predisposition Personality     Education    Vulnerability	Data     Evidence      Public health Physical effects    Dual diagnosis Research       Violence - statistics
Social contradictons and attitudes - 'image' Upbringing       Cultural attitudes  Marketing          Media	Cost per unit      Services        Funding   Cost to health budget      Reporting Policy   Lobbying   Taxes   Commissioning

Beer label c/o http://www.beerlabelizer.com/

'Real Stout' = 'Sale Tutor'

Article 10 of the European Convention on Human Rights: receive and impart information and ideas

Article 10 of the European Convention on Human Rights provides the right to freedom of expression, subject to certain restrictions that are "in accordance with law" and "necessary in a democratic society". This right includes the freedom to hold opinions, and to receive and impart information and ideas.

“

Article 10 – Freedom of expression 1. Everyone has the right to freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and ideas without interference by public authority and regardless of frontiers. This article shall not prevent States from requiring the licensing of broadcasting, television or cinema enterprises. 2. The exercise of these freedoms, since it carries with it duties and responsibilities, may be subject to such formalities, conditions, restrictions or penalties as are prescribed by law and are necessary in a democratic society, in the interests of national security, territorial integrity or public safety, for the prevention of disorder or crime, for the protection of health or morals, for the protection of the reputation or rights of others, for preventing the disclosure of information received in confidence, or for maintaining the authority and impartiality of the judiciary.

”

Well there is clearly one -

purpose
	Political

- in blogging. Many small voices can make a difference.

It is sobering to realise the responsibility; the responsibility that pertains not only when we receive, but also impart information and ideas. Hodges' model can be concerned with both.

Care is needed when ideas have political weight and a health impact; even though when in the guise of public (mental) health such information and ideas apparently lack inertia. You have to wonder about striking the balance. Forget physics - it's the masses that suffer here.

	physic(s)
sick society

For how many decades have the health professions given the government(s) advice on alcohol?

For how long has the negative influence of advertising on children been questioned?

Always the balance.

So hard to find - like Political balls.

My source (and emphasis): Wikipedia
http://en.wikipedia.org/wiki/Article_10_of_the_European_Convention_on_Human_Rights

Simply the best... 4-Domains Pale Ale!

Drugs and alcohol
have permeated
our various cultures and
civilization for millennia.

Our models of health and social care should reflect this. ...

More to follow on drugs, dementia and the Berlin Wall.
I just had to get this out of my system ...

Image sources:

http://www.hbclark.co.uk/clarks-brewery.html
http://www.wordforwine.co.uk/jwlees/index.php
http://www.woodmoorbeer.org/Pages/Snordog_Kenya_Labels.html

Book chapter: Substance Misuse and Mental Health

With the chapter on socio-technical structures within Hodges' model due to appear very soon there is news of an exciting further project - a different publisher with a more purely clinical and social care focus.

Between now and 1 May I have accepted an invitation to produce a chapter addressing the holistic aspects of substance misuse and mental health. More to follow and a deadline to work to ....