Psychiatry itself, is the reason people in psychiatric services are so distressed

Dr Jess shares her thoughts on why mental health services traumatise people in crisis

It’s 3am. I can’t sleep. I have no idea why. I was so tired when I came to bed.

I just saw a post online by a psychiatrist who was saying that people who are critical of psychiatry (like me), wouldn’t last five minutes actually working with people in crisis - and it really did irritate me.

I don’t do back and forths online with people anymore as it’s a horrible, toxic place to discuss anything - but it got me thinking.

Just a thought but maybe the reason so many psychiatrists say that they find inpatient psychiatric facilities and wards so difficult to work in, and so complex/dangerous is because of the environment and system itself.

I read once that, ‘mad places create mad people’. Whilst I wouldn’t use the word ‘mad’ - you get the gist.

In front line work, I’ve worked with people in utter crisis. I’ve talked people down from ending their lives many times. I’ve called the ambulance whilst someone deeply injured themselves after they were raped. I’ve talked for hours with someone who believes the FBI lives in their walls and their TV is spying on them. I’ve been the person who called emergency services whilst the person attempted to kill themselves. I’ve been 1:1 in a room with a guy whilst he graphically described how he stabbed his ex wife. I’ve been coaxed into a room by a sex offender who had joked about raping me moments before. I’ve sat with a girl who became extremely distressed after ECT, because she couldn’t remember where she was. I’ve calmed a woman down who was screaming at me because she thought I had called the police on her, when in fact, they had traced her phone after she made a bomb threat.

Not once have I felt the need to restrain them, inject them, sedate them or lock them up.

Were all those situations frightening? Of course, I’m only human. Were those people in crisis? Absolutely.

However, none of them were locked in a ward, being medicated, being restrained, being cornered, being isolated, being locked away, being forcibly injected. All of these situations I describe occurred in third sector and local authority settings - where we have absolutely no power to medicate, restrain or lock anyone up.

All we have is our people skills. Thousands of professionals and volunteers work in these settings every day. They don’t have prescription pads, or restraint training.

I hear psychiatrists on these platforms all the time say, ‘you wouldn’t last five minutes with actual patients’ - because for some reason, they believe that their wards are the only places that people in total crisis are found.

That gave me pause for thought. Do they really think that they are the only ones working with people in crisis?

They don’t realise that our soup kitchens are filled with people in crisis, our homeless shelters, our rape centres, our child abuse charities, our youth work, our prisons, our police stations, our schools, our PRUs - are filled with children and adults in utter turmoil, displaying violent, aggressive, confused, scared, traumatised, self-harming and suicidal behaviours and thoughts.

Do they think that only they work with humans in crisis? That only those sectioned and in hospital are truly struggling?

And how does the secure hospital environment contribute to the feelings, thoughts and behaviours of someone in crisis?

Maybe those wards and departments are chaos because if you put 20 people in trauma and crisis in a ward where they can’t even have privacy and safety from each other (or staff), whilst they are gaslit, and medicated - maybe, just maybe, it makes them feel worse.

Maybe it scares them to death. Maybe they have nightmares. Maybe they think their families hate them. Maybe they think they’ve gone crazy. Maybe they think they will lose their jobs or their kids now they’ve been sectioned. Maybe they worry they’ll never be ok again. Maybe being pinned down and forcibly injected with a tranquilliser is one of the worst things that ever happened to them - and they know that if they spiral again, it will happen again.

We’ve created such inhumane responses to human suffering, no wonder psychiatrists speak of their work in the ways they do - but make no mistake, this is not because they are simply working with ‘the most mentally disordered patients’ - it’s because they’ve created a punitive environment to put traumatised humans in, and then when they don’t adjust to that terrifying and unfamiliar environment, they diagnose them with further mental disorders and start forcing them to take more medications.

Alternatives are possible. Total reform is possible. Redesign is possible.

But we have to work together, admit what we’ve done, develop real alternatives, and then we have to be brave and actually DO something different.

If nothing changes, nothing changes.