Who gets believed: abuse in mental health services

By Amy Wells, NSUN’s Communications Manager

In the past couple of months, we have seen exposures of a culture of abuse in mental health services. First there was BBC Panorama’s undercover investigation at the Edenfield Centre, a secure psychiatric hospital run by Greater Manchester Mental Health NHS Foundation Trust. This was followed by a Channel 4 Dispatches programme which aired footage captured secretly by a healthcare assistant at two mental health hospitals run by Essex Partnership University NHS Foundation Trust. And most recently, an investigation by The Independent and Sky News reported systemic abuse of patients in units run by the Huntercombe Group, a private company which was responsible for at least six children’s mental health hospitals in the last decade.

These investigations have all reported the physical and emotional abuse, bullying, humiliation of patients by staff, and an excessive use of restrictive and coercive practices such as restraint and seclusion. They follow countless similar investigations and news stories of failings in care across other hospitals under other Trusts.

People on the receiving end of this abuse have spoken out about it for decades. Claims that the investigations are “shocking” are insulting. They give the impression that these are isolated or unique incidents, that it is a case of “a few bad apples”; as if we haven’t heard account after account of abuse in mental health services (and of exclusion from them), such as those published in Asylum Magazine, as if the friends and families of people who have died in custody, including mental health detention, haven’t been marching for over twenty years.

We need to have a conversation about who gets believed: a conversation about power, the systematic silencing of survivor testimony, the weaponisation of mental ill-health, trauma, and distress to discredit and further coerce people who talk about or raise complaints about their experiences of abuse in mental health services.

Mainstream narratives of mental health tend to focus on palatable, sanitised stories of ‘recovery’ – a concept which many consider to have been co-opted by neoliberalism – with the aim of ‘raising awareness’ and very little else. They may go so far as to address long waiting lists and the underfunding of mental health services, but people on the receiving end of harm in mental health services are rarely platformed. Instead, we continue to be told again and again to just reach out to services and systems that we know have harmed many of us. Indeed, how often do we see mainstream accounts of harm in therapy or GP care? Harm and abuse, where they are named, are usually always located in inpatient care – but all mental health services, including therapy and GP care, are places where abuse can and does take place.

People who talk about experiences of iatrogenic harm and neglect, such as experiences of abusive behavior by staff and an environment that is far from therapeutic, or descriptions of a power dynamic that replicates those of abusive relationships that have caused people trauma in the first place, are disregarded and disbelieved. Survivors’ testimonies are dismissed, silenced, problematised and distrusted – a form of testimonial injustice and sanism. They are treated with suspicion, contempt; they may be dismissed as aggressive, malicious, or vexatious.

This is true of countless accounts and ‘stories’ of harm shared more informally, and of complaints made by survivors who face “a complaints process concerned with institutional reputation management rather than bearing witness to failure and learning from it”. The voices of people who have experienced abuse in psychiatric services are not given anywhere near the weight and credibility of the voices of those inside or responsible for the running of services with the power to change things – or alternatively, uphold the status quo. Nor are the voices and experiences of survivors given anywhere near the weight and credibility of those of the journalists and investigators who “uncover” the scandals we have seen recently. Survivor-led recommendations into the changes that need to be made based on people’s lived experiences are not acted upon; the culture of institutionalised care remains the same. 

I have lost faith in the investigations promised when scandals and exposures of abuse come to light. It’s the response we get every time, and yet nothing has changed. 

People must be believed. Iatrogenic harm must be recognised and reckoned with. Those with power – policy-makers, commissioners, service leaders and managers, and mental health professionals – must engage with accounts of abuse in mental health services, such as the just-published Through the Glass Doors, an autobiographical illustrated book co-created by 16 previous patients at CAMHS hospitals run by the Huntercombe Group which details peoples’ experiences and also provides a set of recommendations to those responsible for running these services.

Until people are believed, this cycle will continue. More pain and distress will continue to be caused each time a new scandal is exposed or a new undercover investigation takes place, triggering the new wave of short-lived, hand-wringing responses and claims of shock and outrage which displace blame and soon fizzle out into nothing, with no real responsibility and accountability being taken. 

In the words of Jennifer Reese in the blog she wrote for NSUN last year about her experiences in psychiatric hospital: “For anyone in NHS leadership, executive board members, senior managers reading this I want to say to you – please stop locking up survivors and holding us down, please stop diagnosing us with disordered personalities. Please stop hurting us. We are desperately trying to manage the devastating impact of trauma and mental illness. People are dying because of a lack of support and access to care. Listen to specialist charities and grassroots organisations, listen to survivors about what works for us. Work with us to create safe places where we can heal and try to move on with our lives.”