When Anna* became physically unwell as a student, her GP referred her to a psychiatrist and she agreed to voluntary treatment. After interviewing her for less than an hour, the psychiatrist diagnosed her with schizophrenia and told her there was a risk she would kill her mother.
“I have never been violent in my life, ever,” she says. But for 35 years Anna has had to live with this information, knowing it is written in her medical records and has limited her life opportunities for two decades.
She has since successfully held down a responsible permanent job, bought her own home and been a pillar of the community, but as she observes: “There do not seem to be any spent convictions in psychiatry.”
Violence is sadly commonplace in our world, and it is a spectre that can hang over anyone experiencing distress. But discussion about mental health and violence is largely tied to the punitive attitudes and assumptions of a different age.
There is now an emphasis on mental health service users telling their stories, on challenging prejudice against them, and on treating mental illness like any other health problem. But when people’s mental health problems are linked with killings or violence, the story takes a different turn.
Very sharp distinctions are drawn by politicians and media between the public, who must be protected, and service users, who must be controlled and segregated. This is despite the fact that many high-profile cases have been associated with the failure of mental health services to respond to urgent pleas from service users and their loved ones to intervene and keep them safe. It also ignores the reality that mental health service users are much more likely to be left without adequate support and kill themselves.
Any death associated with the psychiatric system must always be a matter of major concern. But the evidence has long suggested that political and media preoccupations with violence and mental health service users has not been reflected in any major increase in deaths or attacks. The point is not to belittle the problem of violence in relation to mental health but to examine it from broader, fresher perspectives.
Just as modern understanding of disability takes account of people’s circumstances and the barriers they face, so mental health and violence should be re-examined, noting the powerlessness, poverty, racism and other discrimination service users can experience disproportionately.
Drawing on first-hand accounts such as Anna’s, a new book I have co-edited explores how “slow violence” – activity often not even recognised as violence – has been inflicted on mental health service users and people experiencing distress, damaging people over time no less than any physical or emotional assault.
Such slow violence includes public policies that sustain or exacerbate inequalities and poor health for marginalised people, such as gentrification policies that force people out of their neighbourhoods and increase their isolation. It’s also a consequence of psychiatric systems still employing coercion and restraint, in which people are neglected, abused, discriminated against, put at risk and in some cases even die unnaturally.
Far from protecting human rights, many criminal justice systems and laws in areas such as housing, planning and employment push people to the margins of society. Welfare reform policies such as the bedroom tax force people out of homes and communities where they have networks of support into homelessness, poverty and greater distress.
Violence in relation to mental health service users should be seen as a direct consequence of the slow violence of inadequate policy and antiquated treatment.
The latest thinking in physical healthcare focuses on patient participation, prevention and holistic approaches to wellbeing. The same issues apply to mental wellbeing too.
Mental health services have been starved of resources, but much more is needed than simply pumping more money in, however important that is. A radical reassessment is required of how we respond to people’s distress, to move far beyond a narrow emphasis on diagnosis and drugs. We need a fresh eye on the issue of violence in relation to mental health service users, putting it into a broader social and cultural context. This is critical for all our mental wellbeing. Physical health and care has been reimagined for the 21st century, and the same is essential for mental health policy.