The torture, humiliation and harsh punishments of the early asylums are no longer visible across psychiatric wards. Even so, their legacy remains. The protections we have for patient rights in most facilities often do ensure physical abuse is minimised but not entirely prevented. Emotional and perhaps even spiritual abuse still occurs and is inflicted by a set of institutions masquerading as places of compassion and care.

The rhetoric of ‘trauma-informed’ and ‘recovery-oriented’ still has potential to transform mental health systems throughout the world. Unfortunately, this rhetoric is still commonly used to mask sinister and oppressive systems that are not healing their patients. Even those patients who avoid ending up on the revolving door of quick hospitalisations and unmanaged discharges.

It is no coincidence that the themes we can observe in healthcare resemble a horror story. The torturous asylums, the ghosts of neoliberalism, and zombies wandering through eerie facilities are all tragically appropriate metaphors for the modern asylum. There is still hope that we can actually start to acknowledge past failures and truly foster transformational change with patients truly co-producing service planning and delivery. We are completely not in a psychiatric dystopia, but we are still failing to adequately foster care and compassion. We need to tear down these artificial facades and face up to the fact that our systems are rotting from the inside.

Despite all the bastardisation of principles of the recovery movement, there is still hope for transformational change. The peer worker movement and remnants of the psychiatric survivor movement can further upskill and collaborate.

With the ex-patients in charge of governance, management and also all or part of the service delivery, there would still be a need to consciously unlearn the traditional ways of planning and delivering services. We can even reclaim the term asylum and define it more like how we see asylum in the context of asylum seeking in the refugee space. Those experiencing mental illness could be encouraged to seek asylum when they need protection from their current environment in a safer one.

Patients who can see that their workers and the service managers know a bit what it’s like to be in their shoes, will more quickly build trust and respect for that environment. Wards could adapt to the needs of that local community by moving beyond flawed consultation processes to actual employment of local ex-patients and carers. This is a radical change but we are looking at many situations that are life or death. The costs of long stays in hospital, readmissions and immense welfare expenses inherent with current models of mental health completely justify a radical change carefully managed and monitored.

It sounds literally crazy but: looneys should run the looney bin. Ex-patients and carers can lead the radical change we need to disinfect the health system. Ex-patients and carers who have been harmed by these unhealthy systems are best positioned to re-build health based on the needs of patients and not how things have always been done. This system is not broken – it is a self-perpetuating and harmful machine that must be dis-assembled completely. Expecting the cogs in the machine now to change how it operates is pure madness.

This concludes a series of posts ‘Madness on Many Levels’ about the psychiatric system in Australia – view the madness series.