Information & Resources
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Power
One of the biggest problems is the power imbalance between mental health professionals and their clients. Professionals are often seen as the experts on reality and therefore the proper ways to behave, think, and feel. By seeking help, individuals are immediately considered less rational, logical, and reliable than those they are seeking the help from. This can lead to professionals dismissing their clients' concerns, refusing to listen to their feedback and even completely overlooking their physical health or disabilities. This systemic stigma can make it difficult for people to get the help they need and leaves them vulnerable to mistreatment.
Research consistently shows that it is not any specific type of therapy but a positive relationship with your therapist that leads to good outcomes. Unfortunately, not all practitioners got the memo. In the most extreme circumstances mental health professionals can take away someone's freedom, forcibly restraining, detaining, and medicating them. What people might not realise is that the same power-play is present when they are not given enough information to make informed decisions and choices about their healthcare, or when their doctors fail to inform them about the purpose, effects, and potential side-effects of medications.
Anyone who is in a position of power over a child or adult automatically takes on the responsibility of not causing them harm and to being accountable for their actions if this does occur.
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Dogma
There has always been fierce competition between the different approaches used to treat mental health problems. This means that professionals rarely collaborate to create a full picture of why someone is truly experiencing difficulties, although it would greatly benefit their clients. As mental health professionals are not in the business of fixing wider social or political issues, their only option when these things affect their clients’ health is to downplay or ignore them.
For example: A patient is feeling depressed because they have suffered a disabling injury that has left them unable to work and are now attempting to navigate the welfare system. A CBT therapist will try to change their faulty thoughts, a psychodynamic therapist’s approach might treat their childhood experiences as more significant than their present inability to pay rent, and a psychiatrist might write them a prescription for their chemical imbalance.
This battle to prove one form of therapy as more effective and correct than another holds back progress for improving healthcare by decades. Ideologies become ingrained and forms of treatment become too big to fail. Re-training an entire workforce is an almost unimaginable challenge, it’s much easier to downplay the harm caused by the current system and place responsibility for ineffective treatments onto clients. Visit our Your Needs page to find out how you can identify physical, mental and social factors that could be affecting your wellbeing for free.
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Most psychological therapies examine what a person must have done or is continuing to do to cause their current distress. They are encouraged to change their behaviours or just think more positively about real-life difficulties that may be out of their control and harmful to their wellbeing. The narrative of personal responsibility can therefore easily extend beyond accountability and healthy self improvement and into the realm of victim blaming, where an individual is considered at fault not only for their mental state and circumstances, but also for any failure to respond to the treatments being offered to them. On top of this, many therapies place doubt on the accuracy of an individual’s perception. The undermining and invalidation of a person’s reality that lies at the core of many mental health therapies has been described as 'gaslighting'.
This happens throughout society too and empathy for many survivors of adversity and abuse is low. Even though there is evidence that social factors create physical changes to our body and brain this is overlooked by mental health treatments that focus on changing the individual, rather than working to prevent harm from occurring in the first place or accommodating their needs. This is also true for disabilities and neurodiversity (such as autism and ADHD). With many adults having no idea that they are living in a world that wasn't built for them being left to struggle through life and told their difficulties are due to their own personal or moral failings. They just need to try harder.
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Victim-Blaming
Oppression and Scapegoating
Psychology and psychiatry are the scientific authority on defining what is 'normal' and what is ‘abnormal’ in terms of how we should think, feel, or behave. They are professional and academic fields that cannot exist without oppressing some people because they must identify those who are ‘abnormal’ so they can work on making them more like (or more beneficial to) those who are 'normal'.
This means that marginalised people (including those who are non-white, disabled, neurodiverse, queer, etc.) and/or those who have experienced the most extreme adversities (such as poverty, discrimination, and abuse) are the most likely to be harmed by mental health services and treatments. The very folk who need help the most. Instead of being supported to live healthy, meaningful lives where they can achieve their own goals, therapies, medications, and diagnostic labels are in many cases used to identify ways in which patients are failing to adequately meet the norms of society and to subdue symptoms that inconvenience others. Painting them as a drain on public services instead of human beings in need of support. Sound familiar?
Scapegoating is where a person or minority group is blamed for problems so that the wider situation does not need to change. It is common towards children in dysfunctional families and a form of abuse. But it also happens on a much larger scale across society if someone draws attention to a social problem that those in positions of power don't want to have to address. Scapegoats (sometimes unintentionally) make very real and serious issues difficult to overlook by being too loud, too distressed, too sick, or too dead. Many mental health professionals prop up this foul play by branding them as disordered, mad, or bad. We really haven’t come all that far from calling women ‘hysterical’ and telling black people they are mentally ill for trying to be anything other than slaves to white people. The same ideas are still present, just wrapped in more up-to-date socially acceptable language.
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The way the field of mental health operates and treats individuals benefits the needs and views of the most powerful group of people in society. Psychology and psychiatry cannot be separated from current social norms. For example, being gay was only removed as a 'disorder' after society shifted and not because these big institutions pushed for this positive progress from the inside.
Medications, therapies and expert knowledge have been used as tools to 'soft police' individuals, getting them to take on all responsibility for bad circumstances (such as poverty, unemployment, inequality, violence and climate change). Treatments offered by the mental health system also train them to police their own thoughts and behaviours to make them more 'normal'. This means that those in positions of power, employers and governments, do not need to make changes, improve conditions or genuinely create a more fair society. Similar to the claim that you just need to work hard to succeed in life, this trend of hyper-individualism has been skyrocketing since the 1980's and resulted in a boom for the 'positive psychology' movement: Good vibes only, anyone?
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Keeping the Status Quo
How Can Mental Health Professionals and Services Cause Harm?
It's no wonder this topic doesn't get much attention because who would think that health services, charities, academics and therapists apparently committed to protecting and supporting the wellbeing of people (including the incredibly vulnerable) are capable of causing them distress and harm?
Most mental health professionals could never imagine themselves capable of causing harm, never mind doing so deliberately. But there are problems within the field of mental health, the traditional ideas that underpin it and our society that create the right conditions for harm to occur every day.
Changing things would mean that wider society would need to change too, which will take much more than mental health awareness days and promises to tackle stigma.
We hear about the most shocking cases in the news, of lives lost when staff do not fulfil their duty of care, children being denied help or left on waiting lists and the fatal inhumanity of the welfare system. These examples may seem extreme and far away from what you find at your weekly mindfulness group, therapy sessions, psychology class, or medication check-ups.
But the same problems are quietly impacting on us all:
Some Good News
We like to think we are far more advanced and super fancy compared to our ancient ancestors but our bodies and minds did not have time to evolve alongside these advancements. The measure of a good society is not wealth - it is how it treats its citizens. We were not built to live in a world that constantly bombards us with emotional propaganda, telling us what to care about, achieve, think, feel, believe, and who we should be so that we can get paid, fit in, and not make too much of a fuss if things go wrong.
A mental health system, service, academic, or professional who wants to provide valuable support to those seeking help would be challenging this status quo and campaigning for a more just and equal society. Not encouraging it. The good thing is that more and more mental health professionals and organisations are calling out social injustices, adopting trauma-informed practices, listening to feedback, embracing neurodiversity, paying attention to the impact of power imbalances, and campaigning for a more compassionate and flexible system of mental health care. Waking up to the fact they can't keep telling people problems are all in their head. Time to stop sticking cartoon plasters on broken bones and wondering why they never heal.
Underfunding and Austerity
NHS mental health services are underfunded and often understaffed. This means long wait times for treatment and can also lead to mental health professionals feeling stressed, overworked and suffering from compassion fatigue. This inevitably increases the risk of unprofessional actions, cut corners, gatekeeping of services, and harm to their patients.
See below for resources
Links to Resources
1. Underfunding and Austerity
2. Power
3. Dogma
4. Victim-Blaming
5. Oppression and Scapegoating
6. Keeping the Status Quo
World Mental Health Day 2023: View our Open Letter to those responsible for the provision of mental health services in Scotland here.
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