In April 2023, a coalition of nine organisations working across human rights, youth services, racial justice, mental health and policing published ‘Holding Our Own: A guide to non-policing solutions to serious youth violence‘. It is a call for a new approach to tackling what gets called “serious youth violence”, focused on moving away from punitive responses and instead towards investing in community-led solutions.
NSUN’s chapter in ‘Holding Our Own’, which you can now read below, is about violence, harm, and police involvement in mental health services, as well as the community-based approaches to mental health support that we call to be resourced.
Often, we see calls for the increased funding of mental health services as something that could help tackle the root causes of violence. But our chapter looks at the ways in which traditional mental health services can be places where people face violence and harm through coercion, restrictive practice, and police involvement. We call for resourced community-based approaches to mental health support, including investment in user-led mental health organisations, so that people in distress can be supported in ways that prioritise care, choice, and freedom.
At NSUN, when we talk about mental ill-health, distress and trauma, we’re speaking expansively and acknowledging the variety of people’s experiences. Mainstream concepts of ‘mental health’ are often depictions of depression and anxiety – which can be severe and debilitating, but aren’t the totality of mental distress, and aren’t the most stigmatised of conditions, experiences or diagnoses. Included within our communities are people who hear voices and see things others don’t, people who experience “extreme” states, and people who are stigmatised as inherently violent, dangerous or destructive.
In this piece we look at different responses to the spectrum of emotional distress, particularly criminalisation and medicalisation. Both responses can inflict harm and mean that people experience violence at the hands of state institutions.
We want to recognise that emotions that come up around violence, politics, culture, faith, crime, justice and policing are often heavily scrutinised. This is especially true of Black and brown people’s emotions. Sometimes, these emotions are criminalised, as in the recent case in Manchester where texts that a number of Black boys sent expressing grief and anger were used as evidence of criminal activity or intent.
We attempt to look at the material conditions and dangers faced by people who by virtue of their mental and emotional state are considered dangerous, crazy, unreliable or vulnerable. While those experiences are varied, they’re also fertile ground for organising, shared struggle and shared communities of care: the building ground for alternative systems of support. We write this piece in response to calls to ‘fund mental health not the police’, in order to show how mental health is deeply political, and does not begin or end with care.
What we want to dismantle
What is happening to people in crisis?
When you’re in crisis, being placed in mental healthcare settings, like hospital wards, is often involuntary or pressured. When people are sectioned (kept in hospital for a minimum period of time) under the Mental Health Act it can result in hospital stays that are months or years long. It can mean being given treatments you don’t consent to, having your movements seriously restricted, being under constant surveillance and losing access to your benefits, housing, and support system. Huge cuts to services under austerity have stripped away services and choice, especially in communities, so there is often very little say over how people receive support. The choice of how, where, for how long and what kind is often taken away.
Being in distress can also mean that you end up criminalised – being passed on to the police for expressing your distress, and even being held in a police cell or remanded to prison custody for your ‘safety’ (something that Mental Health Act reforms should eventually get rid of).
If you’re a person of colour, you’re up to 40% more likely to enter mental health services through the criminal justice system. People of colour are also more likely to be restrained in mental health contexts, and more likely to be given medication over psychological therapies.
When distress is criminalised, medicalising those emotional responses can sometimes seem like a better or safer choice. Isn’t it safer to be sick than a criminal? Not necessarily: in this piece we explore where the police are present in traditional mental healthcare, and how mental healthcare settings are places where people can experience controlling or punishing behaviour even when the police aren’t directly involved. Criminalisation and medicalisation go hand in hand.
Where are the police directly involved in traditional mental health service provision?
The historically embedded links between policing, prisons, and mental health continue to grow, with society’s dominant psychiatric model and entrenched coercion being ‘violently upheld and enforced by the police, doctors, social workers and other agents of the state’. In this section, we look at where police are involved in mental health services and responses to people in crisis.
Police can be directly involved in the response to crisis, including prosecuting people for alleged offences associated with self-harm or suicidality. Being in distress and asking for help is criminalised. People might be given antisocial behaviour orders, community protection notices or criminal behaviour orders and threatened with prison after suicide attempts.
These practices aim to “deter” suicidality but they go no way towards improving the conditions of someone’s life or their suffering. Instead, they worsen it and deter help-seeking while removing access to care.
Another area where we see the policing of mental health crises is in ‘high intensity use’ models. High intensity use refers to people who frequently use emergency services like Accident and Emergency departments and calling 999. There have been a number of efforts to develop models to stop people from being ‘high intensity’ users of healthcare services. The adoption of the ‘Serenity Integrated Monitoring’ (SIM) model by NHS Mental Health Trusts was brought into sharp relief by the StopSIM coalition of service users, survivors, and allies in 2021. SIM was pitched as reducing demand on services, involving police as interventionists in community mental health teams. Police were given access to service users’ medical records and able to share police records with medical staff.
Police presence in crisis teams uses threats of legal action to pressure people into not seeking help when they need it. Knowing that you might be denied help and even passed onto the police after seeking support means people may not get the care they are entitled to when deeply distressed for fear of rejection or punishment if they reach out.
The StopSIM coalition succeeded in seeing the network that created the SIM model shut down. SIM-like models, however, and other coercive programmes persist in mental health settings.
Prevent, the public sector counter-terror duty, creates an environment in which Muslims, especially young Muslim men, are viewed with suspicion in education, health, the workplace and beyond. ‘The cops are in our heads and our hearts’ and whilst some resist, we are encouraged on a daily basis to remain alert to others’ ‘suspicious’ behaviour.
Even without suspicion of radicalisation, Prevent referrals are used in mental health as a vehicle to ‘speed up access to support’. Racialised young people are shunted into a system of surveillance despite the risks to their safety and wellbeing.
Vulnerability Support Hubs, exposed through investigative work by Medact, show further how mental health settings and the police collude in the ‘securitisation of health’ (practices that involve extending the police system and its logic into healthcare, like surveillance, restraint, and being prosecuted for your distress) where people are coerced into spaces that are extensions of the criminal justice system and their treatment may be influenced by the involvement of counterterror police.
These programmes can’t be separated from the 122% rise in Muslim prisoners in the UK between 2002 and 2015 with Muslims now making up 17% of the prison population. Mental health can be used to target certain communities, like Muslim communities in the UK, making their belief systems ‘symptoms’ of illness.
Prisons and police cells are no longer going to be ‘places of safety’ for people in distress once the law changes. These reforms, however, sit within a context of ongoing securitisation which is not going away and acutely impacts racialised groups.
Who commits harm?
People experiencing mental distress, ill-health or ‘extreme’ states are often stereotyped as violent, particularly if they are Black or a person of colour. But there are types of violence and harm directed at people experiencing distress which are viewed as acceptable, even positive.
Restrictive practice is a euphemism for things that take place in mental health contexts that restrict people’s physical movement, emotional expression, and so on. It can range from 24 hour blanket surveillance without consent, to chemical restraint, and not being allowed outside. Restrictive practice is enabled by the power inequalities that exist in services and systems.
Restrictive practice can be violent and life threatening. What happened to Seni Lewis, piled on by almost a dozen police officers, might have been interpreted or justified by professionals involved at the time as necessary ‘restrictive practice’. It was not. It was a brutal, fatal assault on a young person whose family trusted services to care for their loved one. Staff judged the ‘risk’ to themselves as being more important than the safety and life of someone vulnerable and in crisis. Seni’s family have tirelessly campaigned to right the wrongs that resulted in Seni’s death, including as part of the United Friends and Families Campaign (UFFC). Seni’s Law, or the Mental Health Units (Use of Force) Act 2018 is part of this and it aims to increase protections and oversight on use of force in mental health settings.
So-called restrictive practice is rarely considered assault. In contrast, even small acts by someone in distress can be framed as criminal and punished. The contradictions in how restrictive practice is framed take us beyond mental health: you can be harassed, followed, searched and violated, but those responsible are seen as just doing their jobs.
In their Radical Safeguarding Workbook Maslaha asks people who work in schools to explore the harms which are tolerated to children and young people within a school environment. They argue that learning to see those harms and treat them as unacceptable is a really important part of abolitionist and liberatory progress. Their model can be applied to other settings to show how when people who experience distress or mental ill health are harmed by systems, it can be seen as socially acceptable or even encouraged. In other words, the system isn’t broken, it’s working as intended.
What we want to build
Building as an abolitionist approach
In the mental health context, abolition means dismantling harmful practices found in traditional mental health systems, and building new structures of care and support, rooted in community and mutual aid. It also refers to solidarity across different experiences of marginalisation and discrimination. Abolition is described by Róisín Spealáin as “a new form of social life that values humans over any amount of property, profit or power. It is international solidarity, reparations, anti-imperialism, community, compassion, anti-psychiatry, liberation, justice and an end to exploitation. It is the understanding that illegality and immorality are not the same, that criminal is a word only ever reserved for society’s most downtrodden.”
What does this look like? There are many organisers and groups exploring how we can do things differently, the groundwork for which has been laid by years of transformative abolitionist work in mental health survivor movements and beyond. But just as there is no universal experience of mental distress, there is no universal approach to taking back power and creating alternative systems of care outside of oppressive traditional systems. As China Mills writes in her book, Decolonising Global Mental Health (2014), “frameworks for understanding and responding to mental distress need to be ‘homegrown’ within the local contexts from which distress emerges, privileging the knowledge of those with lived experience of distress, and enabling interventions based on community collaboration, self-help and peer support”.
The role of community
Crisis or Soteria houses are a relatively well-known and somewhat formalised example of community-based, ‘non-coercive’ crisis care, where the aim is to create a place of sanctuary as an alternative to inpatient admission grounded in the idea of standing alongside people and supporting their autonomy, instead of subjecting people to a system of care in which they have little voice or choice. We describe this as “being with” rather than “doing to”.
However, they can often only offer short-term support for an extremely limited number of people. Some are run by the NHS, and for many, people need a referral by a mental health professional in order to access support. This shows how traditional community-based alternatives can be severely limited by underfunding and inaccessibility.
Mental health user-led community groups organising and doing peer support, mutual aid, and more exist “under the radar” in a range of contexts across the UK, meeting needs unmet by traditional mental health service (or charity) provision in ways they know work best for them and their community. Some of them work towards wider transformative justice and abolition explicitly, for example Campaign for Psychiatric Abolition, who fight against policing, prisons, and psychiatry. Their educational resource list provides a starting point for anyone wanting to learn more about abolition. Cradle Community is another collective working towards transformative justice responses to violence in the name of seeking radical approaches to care and healing. Some of them are building alternatives without necessarily naming their work as abolitionist – for examples of some of these, take a look at the profiles of some of the groups we have recently funded at NSUN.
Community-based care doesn’t just look like one thing, but it might have some shared elements. In his piece on policing, morality, and mental health, Shuranjeet Singh considers the elements of a future grounded in community-based support and solutions. He writes that these solutions would: “view health and mental health outcomes as beyond biological causations; be dynamic and responsive to their contexts; work alongside others within their communities to serve populations; espouse compassion and care rather than criminalisation; be held accountable to those they serve and place a primacy on de-escalation”. Ultimately, community-based solutions should absolve the need for prisons and police in mental health, working towards their dissolution from society as a whole.
Community means more than just creating services to respond to mental ill-health, distress or trauma that are based ‘in the community’ as opposed to within traditional services. We also need to think about building systems in society that create conditions in peoples’ lives where they are less likely to reach crisis.
Community alternatives and transformative justice: our vision for the future
What we see right now at NSUN is groups, grounded in community, coming together to develop their own ways of doing things with genuine care at the forefront. We hope to help create a world where their ability to carry out their work is properly resourced and valued, where they and we can work towards transformative justice by building alternative, sustainable strategies of care. In this world, we will be able to name and mourn the injustices that have been inflicted upon people who experience mental ill-health, distress and trauma. We will also have the skills and the resources to fight for change without jeopardising our own mental health or that of others. Young people who feel anger, fear or depression, who act or feel in ways that others don’t, or who see things differently will not be thought of as a problem, a threat or a risk, but as people who give and receive care, with important things to say, who know what they and their communities need.
What we’ve set out in this chapter requires a whole system and structure rethink. To get us on that journey, here are the things we are calling for right now:
- An end to all forms of punitive intervention in schools, hospitals and the community: no more isolation, exclusions, chemical or physical restraint, non-consensual treatment or coercive programmes of surveillance for people living with mental distress like Community Treatment Orders.
- Funded and sustainable spaces for people in crisis to go when they need help with genuine care, including residential care, where support is on their own terms and we acknowledge that help is not neutral. Power that any professionals in these spaces hold over others must be recognised and addressed.
- Resources for communities to take care of their own – to take up space, organise together, and flourish. Many communities have experienced multi-generational deprivation and are targeted by punitive policies like the cap on child benefit. Building genuine alternatives needs resourcing, and their value needs to be better understood and respected by policy-makers and funders.
A common call in disability spaces is ‘nothing about us without us’. We know that ‘us’ means different things to different people. We want space for people to define their ‘us’ and not to be defined by others.
This piece was written by Amy Wells, Mary Sadid, and Ruairi White from NSUN.
Read Holding Our Own: A guide to non-policing solutions to serious youth violene
This report calls for a new approach to serious youth violence, including better funded youth services and a rolling back of police powers