There is no question that mental health care has improved in the Western world since approaches like those at the Bedlam Asylum. The violent, degrading, and unjust treatments of the first asylums are unlike what we see to do -at least what we visibly observe as patients, visitors or staff in psychiatric wards. Instead, there are new modern mechanisms representing a different breed of violent, degrading, and unjust treatments.
Obscure language and information overload of patients acts to disempower them from understanding the system that they are trapped in. High rise hospitals compartmentalise patients into groups by gender, likely aggression and/or perceived severity of their mental illness. Uncertainty about when the patient will be released puts their whole life on hold but then usually abruptly forces patients and their carers to somehow manage without much help back at home or find new homes. In the modern asylum, standalone clinics and mental hospitals comprising clusters of cottages or villas are much less common. Instead, mental health is another division of the hospital apparently requiring the same approach to mental illness as any physical illness with rapid emergency care then constant checking of vital signs.
Should we take the vital signs of the modern hospital, they’d appear to be critically unhealthy. Staff are overworked and often unmotivated to make the most needed quality improvements. Patients are justifiably angry over the lack of support and attention they are getting and the general coldness of many staff who have become numb as a coping mechanism or never cared in the first place. Managers blame lack of funding but are fully aware of all the wasted funds they allow to bleed out of their hospitals. Carers are left in the dark most often but still so critical to the recovery of their loved ones. Further, ex-patients carry the trauma of the difficult experiences caused by their illness on top of often highly distressing admissions to hospital and times when they have been turned away without care or discharged well before they are ready.
This series of posts offers a critical reflection from first hand experiences as an ex-patient. This is also somewhat of a manifesto on what needs to change in our mental health systems. Readers who are ex-patients should be able to reflect on the themes and how their experiences differ while workers/clinicians use the lived experience, academic evidence and opinion here to do better. We are a long way from delivering mental health services that are both empathetic and effective. Psychiatry – perhaps the least empathetic of the clinical professions – is still in its infancy as a pseudoscience with some shameful origins which must be left in the past.
The evidence used for observations, suggestions and interpretations of current psych ward practices includes an even balance of lived experience as an ex-patient across 6 different public or private psych hospitals, work experience across 9 psych wards spread over 3 hospitals combined with academic and desktop research. Through my PhD. studies, I looked at the role of institutional forces like norms, laws and ways of thinking and how they shaped decision-making. Likewise here, the theoretical underpinning of this real-world analysis of mental health care settings is institutional logics (from new institutional theory) which are very fixed and limited ways of acting for ex-patients, clinicians and managers.
Fortunately I am at a point in my recovery from mental illness where I can critically reflect on my experiences as an ex-patient and mental health worker. I have used the lenses from my management, education and sociological studies as a participant observer. I have also performed action research in terms of studying clinician-patient interactions and then seeking to educate both clinicians and patients to better support these relationships. Something here was missing though. Changing the system from within is impossible when you become encaged by that system.
These blog posts and related advocacy work should also act as a call-to-action for policymakers. Funding needs to increase where it is needed most and outcomes that matter most to patients must be better measured and openly reported on. For advocates and activists, we must demand this data then use it to hold our political leaders to account.
Patients are faced by systems that may have shiny and expensive new buildings but lack heart and substance. We are seeing pockets of despair, the deterioration of empathy, and the numbing apathy of consumerism despite the facade of new hospitals. Hospitals are still places where lives are saved but this does not justify situations where lives are destroyed. Opportunities to more effectively prevent suicide, self-harm and chronic mental illness should not be missed but too many current treatments and approaches to service delivery are deeply codified but masked by artificial facades of language and new multilevel buildings that pretend to act like hotels.
The madness permeating through the modern asylum starts at the foundations in the dark times of the original asylums. The next level is the ground floor with the revolving doors of refused services or regular readmission. The shiny facade seems nice enough for those viewing the hospital as community members or visitors but this is an artificial consumerist shell encasing decay and dysfunction. Service delivery and promotions are further masked by a facade of falsities and euphemisms in the language of health consumerism. Up on the wards both patients and staff are encouraged or coerced into becoming the walking dead with the modern asylum sucking the life out of their unique identities and suffocating most compassion. While this madness is enshrined in professions and institutions, ex-patients are the only hope for transforming these systems but must avoid the revolving doors for long enough while upskilling and unlearning the unhealthy systems of the status quo.
Next Madness Post: The Legacy of Bedlam
