I have been in mental health services of all sorts for the past eight years: I have had counselling, years of psychotherapy (psychoanalytic and psychodynamic), dialectical behaviour therapy, and I have also been under the care of the crisis team and the community mental health team. Some of these experiences were good and I have greatly benefitted from them (I will write a post about the positive experiences as well), but I have also had appalling care.
In this post I would like to focus on one particular negative experience of mental health services, as I believe this experience is particularly indicative of the systemic issues within the services in how those with mental health issues are perceived and, as a result, treated. Below are three instances from a recent interaction with a counsellor who, although generally polite and probably well-meaning, during our 45 minute initial assessment managed to display a shocking amount ignorance and profound lack of understanding.
First, she asked me what my plans were after I finish my PhD (note that I am here as an EU student from Croatia and I recently married a British guy, which she knew) and I replied that I would like to probably continue as a researcher but also a mental health activist. She then proceeded to comment that I must feel very lucky that now that I am married I am allowed to remain in the country.
To be clear, I am allowed to stay in this country as an EU citizen and have more than enough qualifications to be hired in this country regardless of my marriage. First of all, I do not understand why she felt it was necessary or appropriate to mention this at all. At that point she knew me for about 5-10 minutes, and the last thing I expect when I come to a counsellor is to talk about my legal rights to remain in the country. Secondly, if you do not know the basics about the EU or Croatia, either do not flaunt that lack of knowledge or simply ask me. The matter is made worse by the fact that she works for a service that is a part of a large international institution, so I am questioning her ability to be able to relate to and engage with people of colour and/or non-European nationalities.
Next, she asked me how my husband deals with my (mental) illness and when I said that he deals with it very well and is very supportive, she added that it must be very nice to have someone accept me as I am. Now this may seem like an innocent comment but it is not at all. I have heard this over and over again from many well-meaning people who usually praise David (my husband) for sticking with me through my mental illness and I have even been told that I am lucky because he hasn’t left me. On the other hand, no one ever suggested anything similar when David was diagnosed with cancer and in fact, I have never once been praised for the support I have given him (in part because I am a woman). The idea that mentally ill people are difficult and do not deserve the same support/love/acceptance as those with a physical illness is still as pervasive as ever, even among the professionals!
The conversation then moved to David’s illness (blood cancer) and she asked me how he deals with it. I said that he is very mentally stable which in no doubt helps him deal with it quite well. The counsellor commented that “it must feel nice to have someone so normal in my life”. I guess she meant to use the word “stable” but the fact that the word normal slipped in shows you just how she views me and my illness. I personally do not consider myself not normal in any way, but it is clear she does.
Now, you might say well why don’t you complain to someone about it! Unfortunately, we are not at a restaurant where the customer is always right (and even then most people I know will feel too uncomfortable to complain), but a part of a system where the service user by default is not right. The fact that you are mentally unwell often means mental health professionals view you as having little or no agency, and not being able to think rationally and objectively. In such a balance of power it is very difficult for the “mentally unwell” to disagree with the professionals and express dislike because, often if they do, they will be seen as difficult and uncooperative, and their objections will be perceived as a direct product of their unwell minds and, as such, dismissed. This, of course, is nonsense because a person does not exist one-dimensionally as only mentally unwell at any given time, and because one is struggling with their mental health does not immediately rob them of the rest of their personality and ability to think. However, the pervasive view that we are somehow “not normal” and irrational makes complaining impossible, especially when you are at your most vulnerable.
Another reason why I did not complain, and instead arranged another appointment, is that I don’t really have a choice. I would prefer to go back to my private therapist but I can’t afford it at the moment, and the NHS waiting lists are about 9 months if you are lucky. If I wait that long, my now minor issue will slowly turn into a beast that will start suffocating me. So the only other option for me is to access this particular service, which is free and the waiting time was only a week. If I complain, I know I will ruin the slight chance that this counsellor might actually help me, and for now this slight chance is all I have.
What makes this kind of systemic and subtle abuse particularly horrible is that the people who access mental health services are usually at their most vulnerable and it is very easy to convince them that they can’t get and don’t deserve anything better. To use a popular metaphor, it’s like kicking a man while he’s down. Most people with mental health issues already have low-self esteem and feel guilty for their existence, usually as a result of years of invalidation and mistreatment. The job of the mental health services should be to help, not to contribute to the invalidation and mistreatment that led them to the services in the first place.
However, mental health professionals are not exclusively to be blamed for their ill-practice because they are also a product of a wider structure in which they were educated and work. The mental health services we have are a direct reflection of the society we live in i.e. we have created them to reflect our societal values. So if we want to see a radical change in mental health services, we need to address the underlying believes we hold about mental health, mental illness and suffering on both the individual and societal level.