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Ramadan: your questions answered

A brief guide for the curious, the bored, the uninformed and the ignorant.

Some of you may have noticed that it is the Islamic holy month of Ramadan. My stomach has. I can hear it groaning as I type this post. I won't be eating anything till 8.38pm.

I've been fasting since I was about 12 or 13, and every year I'm asked the same bunch of questions about Ramadan by well-meaning non-Muslim friends and colleagues. So I thought I'd use this blog post to answer some of these common queries.

Here we go:

What is Ramadan?

It's the ninth month of the Islamic calendar, when Muslims all over the world spend 30 days observing the fast. Muslims believe it is a blessed month; it is the month in which we believe the Quran was first revealed to the Prophet Muhammad.

So you don't eat for 30 days? Is that physically possible?

Sorry, what? There seems to be some confusion about the timing of the fast. The fast takes place from sunrise to sunset each day, for 30 days, that is to say, during daylight hours only. We don't actually fast for 30 whole days in a row -- that would be impossible, if not worthy of a permanent place in the Guinness Book of Records.

You can drink water, right?

Nope. No water, no juice, no milk, no liquids whatsoever. In fact, the list of "prohibited" items and activities in Ramadan is fairly comprehensive: no food, no drink, no smoking, no drugs, no sex, no bad language or bad behaviour whatsoever, from sunrise to sunset each day. That's the challenge.

But doesn't that damange your health?

Hmm. I haven't noticed my fellow Muslims dropping like flies around me, as we fast together each year. Millions upon millions of Muslims, in fact, have been fasting for centuries without falling sick, toppling over or suffering from premature death. Fasting, contrary to popular opinion, doesn't damage your health. Vulnerable individuals – the sick, the elderly, children, pregnant women – are exempt from the requirement to fast. And then there is the range of academic studies which show several health benefits arising from Ramadan-type fasting, "such as lower LDL cholesterol, loss of excessive fatty tissue or reduced anxiety in the fasting subjects".

So do you end up losing weight at the end of it?

I can't speak for others, but I always end up putting on weight because I eat so much every night, at iftar time, to compensate for not having eaten all day! From my own experience, few Muslims treat Ramadan as a period of dieting, or use the fast to lose weight.

Why is Ramadan in the summer this year? Didn't it used to be in winter?

Since 622AD, and the time of the Prophet Muhammad, Islam has operated on a lunar calendar, with months beginning when the first crescent of a new moon is sighted. As the Islamic lunar calendar year is 11 to 12 days shorter than the solar year and contains no leap days, etc, the date of Ramadan moves back through our calendar each year. (For example, a few years ago, Ramadan coincided with our winter; the days were shorter and the fasts were easier!)

What is the point of starving yourself for 30 days?

Ramadan is a deeply spiritual time for Muslims. By fasting, we cut ourselves off from the distractions and temptations of our busy, hectic, materialistic lives and try to gain closeness to God. The Quran describes the main purpose of the fast as being to "attain taqwa", or "God-consciousness". We use the fast to try to purify and cleanse our souls, and to ask forgivness for our sins. We also learn self-restraint and we become much more aware of those less fortunate people around us for whom "fasting" is not a choice, for whom hunger is part of daily life. The fast is an act of worship and a spiritual act; it is also an act of social solidarity.

Mehdi Hasan is a contributing writer for the New Statesman and the co-author of Ed: The Milibands and the Making of a Labour Leader. He was the New Statesman's senior editor (politics) from 2009-12.

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British mental health is in crisis

The headlines about "parity of esteem" between mental and physical health remain just that, warns Benedict Cooper. 

I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant.

Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens.

Not that Nottingham is alone - anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community services’ budgets are piling the pressure on sufferers and staff alike.

It’s particularly twisted when you think back to solemn promises from on high to work towards “parity of esteem” for mental health – i.e. that it should be held in equal regard as, say, cancer in terms of seriousness and resources. But that’s becoming one of those useful hollow axioms somehow totally disconnected from reality.

NHS England boss Simon Stevens hails the plan of “injecting purchasing power into mental health services to support the move to parity of esteem”; Jeremy Hunt believes “nothing less than true parity of esteem must be our goal”; and in the House of Commons nearly 18 months ago David Cameron went as far as to say “In terms of whether mental health should have parity of esteem with other forms of health care, yes it should, and we have legislated to make that the case”. 

Odd then, that the president of the British Association of Counselling & Psychotherapy (BACP), Dr Michael Shooter, unveiling a major report, “Psychological therapies and parity of esteem: from commitment to reality” nine months later, should say that the gulf between mental and physical health treatment “must be urgently addressed”.  Could there be some disparity at work, between medical reality and government healthtalk?

One of the rhetorical justifications for closures is the fact that surveys show patients preferring to be treated at home, and that with proper early intervention pressure can be reduced on hospital beds. But with overall bed occupancy rates at their highest ever level and the average occupancy in acute admissions wards at 104 per cent - the RCP’s recommended rate is 85 per cent - somehow these ideas don’t seem as important as straight funding and capacity arguments.

Not to say the home-treatment, early-intervention arguments aren’t valid. Integrated community and hospital care has long been the goal, not least in mental health with its multifarious fragments. Indeed, former senior policy advisor at the Department of Health and founder of the Centre for Applied Research and Evaluation International Foundation (Careif) Dr Albert Persaud tells me as early as 2000 there were policies in place for bringing together the various crisis, home, hospital and community services, but much of that work is now unravelling.

“We were on the right path,” he says. “These are people with complex problems who need complex treatment and there were policies for what this should look like. We were creating a movement in mental health which was going to become as powerful as in cancer. We should be building on that now, not looking at what’s been cut”.

But looking at cuts is an unavoidable fact of life in 2015. After a peak of funding for Child and Adolescent Mental Health Service (CAMHS) in 2010, spending fell in real terms by £50 million in the first three years of the Coalition. And in July this year ITV News and children’s mental health charity YoungMinds revealed a total funding cut of £85 million from trusts’ and local authorities’ mental health budgets for children and teenagers since 2010 - a drop of £35 million last year alone. Is it just me, or given all this, and with 75 per cent of the trusts surveyed revealing they had frozen or cut their mental health budgets between 2013-14 and 2014-15, does Stevens’ talk of purchasing “power” sound like a bit of a sick joke?

Not least when you look at figures uncovered by Labour over the weekend, which show the trend is continuing in all areas of mental health. Responses from 130 CCGs revealed a fall in the average proportion of total budgets allocated to mental health, from 11 per cent last year to 10 per cent in 2015/16. Which might not sound a lot in austerity era Britain, but Dr Persaud says this is a major blow after five years of squeezed budgets. “A change of 1 per cent in mental health is big money,” he says. “We’re into the realms of having less staff and having whole services removed. The more you cut and the longer you cut for, the impact is that it will cost more to reinstate these services”.

Mohsin Khan, trainee psychiatrist and founding member of pressure group NHS Survival, says the disparity in funding is now of critical importance. He says: “As a psychiatrist, I've seen the pressures we face, for instance bed pressures or longer waits for children to be seen in clinic. 92 per cent of people with physical health problems receive the care they need - compared to only 36 per cent of those with mental health problems. Yet there are more people with mental health problems than with heart problems”.

The funding picture in NHS trusts is alarming enough. But it sits in yet a wider context: the drastic belt-tightening local authorities and by extension, community mental health services have endured and will continue to endure. And this certainly cannot be ignored: in its interim report this July, the Commission on acute adult psychiatric care in England cited cuts to community services and discharge delays as the number one debilitating factor in finding beds for mental health patients.

And last but not least, there’s the role of the DWP. First there’s what the Wellcome Trust describes as “humiliating and pointless” - and I’ll add, draconian - psychological conditioning on jobseekers, championed by Iain Duncan Smith, which Wellcome Trusts says far from helping people back to work in fact perpetuate “notions of psychological failure”. Not only have vulnerable people been humiliated into proving their mental health conditions in order to draw benefits, figures released earlier in the year, featured in a Radio 4 File on Four special, show that in the first quarter of 2014 out of 15,955 people sanctioned by the DWP, 9,851 had mental health problems – more than 100 a day. And the mental distress attached to the latest proposals - for a woman who has been raped to then potentially have to prove it at a Jobcentre - is almost too sinister to contemplate.

Precarious times to be mentally ill. I found a post on care feedback site Patient Opinion when I was researching this article, by the daughter of a man being moved on from a Mental Health Services for Older People (MHSOP) centre set for closure, who had no idea what was happening next. Under the ‘Initial feelings’ section she had clicked ‘angry, anxious, disappointed, isolated, let down and worried’. The usual reasons were given for the confusion. “Patients and carers tell us that they would prefer to stay at home rather than come into hospital”, the responder said at one point. After four months of this it fizzled out and the daughter, presumably, gave up. But her final post said it all.

“There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief”.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.