Systemic abuse in helping services impacts all of us
‘Systemic abuse’ is not a new phenomenon in the mental health and social care world
There is little point in reducing waiting times or improving access to mental health services if we are re-traumatising people when they get there.
The ‘systemic abuse’ recently reported across multiple media sites is not a new phenomenon in the mental health and social care world. Being pinned down, force-fed and drugged into a ‘zombie-like’ state has been happening for decades. Institutional abuse occurs across learning disability, mental health and children’s services. It has been well documented and we have known about the inherent power issues these provisions present for decades. How the mental health diagnostic system was constructed is subject to these same controversies and has been criticised for cultural imperialism and enacting particular moral values rather than scientific consensus on many occasions since its construction. There are many studies showing unfair and disproportionate use, and an acute over-medicalisation of the distress women, LGBTQ+ people and people racialised as black experience.
The Stanford Prison Experiment
You may be familiar with the famous Stanford Prison Experiment by Zimbardo and colleagues that took place in 1971. Seeking to explore the psychology of power and powerlessness, twenty-four students were carefully screened and randomly assigned into groups of prisoners and guards. The experiment, scheduled to last 1-2 weeks, had to be terminated on only the 6th day as the experiment escalated out of control with the prisoner’s group being forced to endure cruel and dehumanising abuse at the hands of their peers. The experiment showed, in Dr. Zimbardo’s words, how “ordinary college students could do terrible things.”
This was over 50 years ago and today we still have a mental health act and a mental health system that has not addressed this power abuse dynamic. This is apparent in recent repeated reports of abuse in the media; the Huntercombe Group, Edenfield, Hillview Ebbw Vale, and Ty Coryton Orbis. As you can see Wales is not immune to this issue.
Whilst the closure of asylums and long stay hospitals should be celebrated what has effectively happened in many instances is the unintended creation of ‘mini institutions’. The 1983 All-Wales Mental Handicap Strategy remains an inspirational document today but it also remains unrealised as we are yet to get to the core of the problems at play.
An urgent need for a paradigm shift in our approach to mental health, substance use and social care.
It doesn’t need to be like this. There are many things we could do to alleviate the issues in the short term as well as eradicate them over the long term. There is an urgent need for a paradigm shift in our approach to mental health, substance use and social care. United Nations Special Rapporteur on the right to health, Dr. Dainius Pūras, said in his 2017 report on mental health. He called for a “revolution” in mental healthcare and a move away from the biomedical model and “excessive use of psychotropic medicines.” He said; “We need little short of a revolution in mental health care to end decades of neglect, abuse and violence. Mental health policies and services are in crisis, not a crisis of chemical imbalances, but of power imbalances.”
We welcome the Welsh Government’s efforts to remove profit from children who are in care. The commitment to remove profit from children’s social care is part of the recent cooperation agreement between the Welsh Government and Plaid Cymru. This is a huge step forward for our already vulnerable children that speaks to addressing the important role power plays here. We need to next see the same considerations extended to our children’s and adult’s mental health private care system too.
This is an issue for everyone, not just the ‘one in four’ of us.
At Platfform, we are driven by the understanding that a rights and strengths-based approach is the foundation of sustainable emotional health for everyone. We have two key aims. The first is to change the dominant narrative around mental health by advocating for the role that trauma, life experiences, socio-economic circumstances and power have on our mental health and ability to heal. The evidence is there but as the recent study by Moncrief and colleagues showed that 90% of the public still believe that depression is caused by a chemical imbalance.
In order to shift public perceptions and understanding, we must ensure the evidence base is accessible to people and that industry motivations do not obscure what information is put forward. So that people can understand that our mental health is not caused by specific genes or chemical imbalances but that it is a much more complex and holistic picture. One that is largely determined by our circumstances. Through how power and injustice is operating in our lives. The important part to this story here is that it is healthy circumstances and relationships that help us heal. This requires injustice and power imbalance to be addressed too. This is why we need our mental health services to be part of the solution, not part of the problem.
Our second aim is to make our ‘helping systems’ work better for people by changing how we provide services to people in distress. Specialist mental health services must work compassionately with people not re-traumatise them.
In order to do this, we must stop putting the issue of mental health onto the person and blame them or think of ‘them’ as second-class citizens but we must recognise the role adversity, trauma, distress and injustice have on our mental health.
Well-meaning statements like ‘one in four people will experience a mental health problem’ imply that poor mental health occurs equally and randomly across the population according to the fate of our levels of ‘personal resilience’ or biology. But this is not true. It’s about what’s happened to us, what emotional needs we didn’t or aren’t getting met and what impact this then has on our mind, body, and soul.
This means it is not just a problem for the ‘one in four’ of us, it is an issue for everyone. Every single one of us experiences distress, pain and suffering. This is part of our human condition. Therefore, mental health is relevant to all of us. The intergenerational nature of trauma and distress means this is a problem for our future generations too. This means any one of us or our family could come to need and depend on mental health services. Wouldn’t you want to ensure that experience helped you rather than made things worse? I know I do.
