Editorial: What’s happening in mental health services? by H. Spandler

This is the editorial for the Winter 2022 issue of Asylum (29.4).


Recent documentaries have highlighted human rights abuses on UK mental health wards. The BBC Panorama programme exposed a culture of sadistic behaviour towards patients at the Edenfield unit in Greater Manchester and the Channel 4 Dispatches programme exposed the brutal treatment of suicidal young people in Essex hospitals. Both highlighted the punitive use of restraint and seclusion. Subsequently, Sky and The Independent highlighted the abuse of young people in a group of private hospitals run by the Huntercombe Group; and a series of young women’s deaths have been associated with a catalogue of failures in Tees, Esk and Wear Valleys (TEWV) Trust. It seems likely more scandals will follow.


We should be under no illusions that these exposés were isolated incidents. They revealed a thoroughly broken system, prone to abuse and neglect. Whilst the level of abuse was shocking, in many ways we were not surprised. The abuse and neglect of mad, distressed and psychosocially disabled people has a long history. This history is deeply entangled with carceral, psychiatric and medical systems. However, it cannot easily be reduced to these systems either. Historically, psychoanalysts have suppressed women’s lived experiences of sexual abuse and mental health systems still failed to fully understand the long-term impact of abuse. In addition, LGBTQ+, autistic people and people with unexplained medical symptoms such as ME/CFS have been pathologised and harmed though psychologising frameworks.


Moreover, although mental health systems are clearly guilty of causing profound harm, this cannot be separated from wider regimes of power, oppression & inequality. Our current situation reflects a society which demonises and punishes sick, disabled & vulnerable people through increasingly punitive welfare regimes. It is inseparable from a society that is running down health and social care services and failing to provide basic – let alone therapeutic – support for its members.


Rather than addressing these failures and abuses of power, lots of energy is spent in fractious debates on social media, arguing about competing ‘models’ of mental health care. It seems clear that the underlying problems will not be resolved by one-off inquiries, the scapegoating of individual staff and a re-assertion of ‘usual practice’. But neither will it be resolved by the simply shifting from one ‘model’ to another, without addressing these wider and deeper issues. Perhaps we need to spend less energy arguing about models and turn our attention to challenging the abuse of power. After all, the current system isn’t necessarily treating people as ill, traumatised or psychosocially disabled, but as individuals who should be blamed for their own distress and viewed as culpable for failing to survive or recover.


Despite repeated ‘anti-stigma’ and ‘mental health awareness’ campaigns, people with long-term needs – especially women – are increasingly treated as manipulative, denied treatment and support, and sometimes even criminalised. In addition, psychological, medical and social interventions can be used, or sometimes withheld, to threaten and punish people for psycho-social transgressions, or for failing to conform to treatment regimes. This situation demands a pro-active response, condemning individual abuse and system failure. It also requires imaginative and creative methods of protest to bring people together.


The day after the Panorama exposé, CHARM called a public vigil in Manchester. Protesters held a minute’s silence for all the people abused and neglected in mental health systems and people brought teddy bears to show solidarity with patients. One young woman in the Panorama documentary was shown being restrained, mocked and secluded, for weeks on end. She wasn’t allowed any personal possessions, even her teddy bears, demonstrating a heart-breaking lack of care and compassion. Local service user organisations, grassroots workers, family members, activists and trade union activists came to show their support (although a national Trade Union voice was sadly absent).


Asylum has been publishing survivors accounts of mental health systems for nearly 40 years. We will continue to do so. We joined the CHARM vigil and we include an article by CHARM activists, and photos from the vigil, in this issue. We have also joined various individuals and organisations calling for a full independent public investigation of all mental health services across the country – in-patient and community (for example, On the Inside). Survivors, families and allies, need to finally be heard, to really acknowledge, and provide redress for, the harms caused by these systems. We need truth, justice and change.


Asylum has always provided a space for survivor’s experiences, critiques and alternatives. However, we recognise that both mainstream and alternative approaches – however well-intentioned – do not exist in a vacuum. They are all shaped by wider contexts and, therefore, not immune from abuse and critique. In this issue of the magazine, Wren Aves highlights how ‘critical’ anti-diagnostic frameworks can be dangerous, especially in a system with inbuilt power imbalances and a society that denigrates people who require ongoing support and welfare.


In our current context, welfare systems can end up weaponising even seemingly radical ideas against people. What might feel progressive in one context, may prove damaging in another. That insight can be deeply challenging and unsettling for us all. However, it’s crucial that we are aware of this possibility, lest we end up reproducing harmful systems in practice. For these reasons, rather than aligning ourselves with any one alternative framework, Asylum will continue to provide a space for a wide range of experiences, critiques and radical ideas. In this way, we are committed to remaining an independent critical voice in the radical mental health field.


We also seek to make links with mental health struggles in other countries. Our cover image refers to historic institutional scandals in India (Erwadi) and Greece (Leros) as well as the UK, highlighting the Global nature of human rights abuses. This issue includes contributions from across Europe, including Greece, Belgium, Switzerland, the Czech Republic and Italy as well as the UK and US. Vinzenzo Passante, for example, reports on the ongoing struggle to defend the Italian democratic psychiatry movement in Trieste, a movement which initially inspired Asylum.


The Hysterixx are not laughing attests to the continuing silencing and oppression of women in our mental health systems. Our contributors bear witness to the power of personal testimony, persuasion and well-directed anger, but also humour and creativity – see contributions from Dolly Sen and the Hospitals Rooms project. We welcome our new poetry editor, Janine Booth, who contributes one of her own poems, asking ‘Is it really OK not to be ok?’ We also pay tribute to several survivors we have tragically lost.


It feels dispiriting if it takes public exposure of the systematic cruelty and abuse of psychiatric patients to bring people together. But at least it provides an opportunity to further highlight these issues and find ways to support more compassionate ways of alleviating suffering. Whatever frameworks, models or theories we prefer, and whether we support the abolition or reform of psychiatry, the abuse and neglect of people who use, need or survive mental health services abuse is never acceptable or excusable. We need to unite to understand and challenge abuse and neglect – whatever form it takes.



Return to Asylum 29.4