Amidst all the public discussion of the NSW psychiatrists’ pay dispute, there has been little focus on the needs and concerns of people who have been harmed by psychiatric care, says Grace White, a disability rights advocate and psychiatric survivor.
Grace White writes:
I see Cumberland Hospital from my office window as I write. Formerly, Parramatta Psychiatric Centre. Formerly, Parramatta Mental Hospital. Formerly, Parramatta Hospital for the Insane. Formerly, Parramatta Lunatic Asylum.
The mass resignation of NSW psychiatrists brings a familiar frustration to many who have experienced the worst of the mental health system, and whose voices and concerns are too often left out of public debate.
I am a psychiatric survivor, someone who has been harmed not simply by way of misfortune or system failure, but by cruelty and violence.
I was a teenager when I was first betrayed by the institution of psychiatry. I spent four years oscillating through inpatient treatment and heavily-surveilled outpatient ‘care’. During that time, my physical and mental health deteriorated.
I experienced abuse, neglect, coercion, chemical restraint, and exploitation. I was groomed, and sexually harassed repeatedly by a hospital staff member. My soul got sick.
No one believed me, so I couldn’t believe myself. I stowed the hurt away in hidden memories until they ruptured through the seams.
Shared conversation
Recently I spoke with Inaugural Deputy Commissioner of the NSW Mental Health Commission, Fay Jackson EBE. Fay is a voice-hearer, and sustained permanent injury from involuntary medication under enforced treatment and Community Treatment Orders.
We fell into an unfurling of astute observation, for which the Mad are notorious.
I reflected on how psychiatrists would tell me what everything means, and that I absorbed a need for clinical translation of feeling.
Fay nodded, “You forget how to be quizzical.”
I was struck by her use of this word. I noticed how it positioned the consumer ‘outside’ of a clinical discussion, able to observe the practice with a critical lens and at times, bemusement at its absurdity.
I found the mix of critique and quiet humour particularly empowering, reminding me of the importance of consumers having the autonomy to think critically, challenge the process, and make our own meaning outside of how we are defined by medical constructs.
Power in process
Psychiatrists talk about patient safety, pay parity, and moral injury.
It is difficult to hear them use doom-based messaging to negotiate for higher pay and safer working conditions. It is gruelling to hear consumer lives used as a bargaining chip.
This ability to leverage the fallout of resignation indicates a deeply entrenched power imbalance in the current system. The stunting of alternative models, including Peer Operated Services, has fostered a disciplinary dependency.
Recent discourse mirrors traumatic experiences of many who have survived psychiatric violence. There is a deep sense of institutional betrayal, abandonment, hypocrisy and coercion as those with clinical power decide what is best for us, and then walk away.
I grit my teeth watching the issue of moral injury receive greater attention than human rights violations occurring in mental health settings.
Fay asks, “If psychiatrists can’t cope with this, how are we supposed to?”
Pay parity will not address the social determinants of moral injury.
Media coverage of the exodus has been strikingly apocalyptic. The word ‘catastrophe’ seems reserved for speaking about the mental health system, while telling consumers not to ‘catastrophise’.
Informing people of their imminent doom is anxiety-provoking. Fear-based messaging misses the mark when you’re still restraining deeply frightened people.
Fay highlighted how recent coverage has increased community misconceptions about mental health and violence. “Psychiatrists say we’re vulnerable, but they’re making us more vulnerable by drumming up fear about us.”
While psychiatric peaks have tossed us an apocalypse, consumer representatives see this an opportunity for rights based models and person-led care.
‘Not all psychiatrists’
I hold no doubt lives are saved in emergency rooms and through ongoing care from committed clinicians.
Some people benefit from violent systems. This does not make them less violent. Not all psychiatrists are bad. There are good psychiatrists – just as there are good men.
All have an obligation to challenge the oppressive system of which they are actors and beneficiaries.
Fay and I spoke about goodness, badness, and Madness.
She too recognised the dedicated clinicians within the public system. However, she questioned what ‘safe working conditions’ means in these negotiations.
We have both witnessed and felt the distressing cultural issues within psychiatry. Like survivors, dissenting stories within the field itself may struggle to find their way to the microphone. Silence culture does not foster ‘patient safety’.
On resignation, I empathised with the writhing urge to get out of an institution before it eats you alive. Fay told me, “You can’t heal in an environment that is governed by bullying.”
The greatest threat to psychiatry is its own culture. An ego-driven and patriarchal God-complex that eats its own while hurting those it claims to save.
The beauty of talking to psychiatric survivors is that we are so profoundly under-estimated, frontline secrets are not well-hidden from us. There is an assumption that regardless of what we witness, no one will listen.
Were the alliance ever equal, some survivors would make the good psychiatrist’s greatest ally. Currently, we sit backs-turned, arms-crossed, pulling at different threads of the same antiquated tapestry.
Fay calls for person-led care, including a well-resourced peer workforce. These evidence-based models de-centre coercive and restrictive approaches, empowering those most affected to be in control of their recovery.
She emphasises that these frameworks are not ‘anti-psychiatry’.
They reposition psychiatrists as collaborative support, rather than the decision-maker. It’s a difficult pill to swallow, but this dethroning produces cost-effective, socially beneficial services for all stakeholders.
‘A letter to the Good Psychiatrist’
You are the human glitch in a dehumanising system. Moral injury only marks the mortal. It is time for you to de-program, and open your minds to new ways of healing.
Stop continually reforming a system that requires transformation.
Advocate for ‘patient safety’ by protecting the rights of every person.
Collaborate with lived experience representatives in the elimination of restrictive practices.
Demand immediate improvements to the NSW Mental Health Act to prevent morally injurious interventions.
Advocate for, and engage in, processes of restorative justice.
Support the implementation of Peer Operated Services.
Work with consumers and representatives in policy development.
Embrace person-led models, and your role within them.
Remain benevolent, but never indispensable.
Survivor voices are as challenging and diverse as they are integral.
Join Fay and I in questioning, critiquing and transforming systems.
And in conclusion…
While there is increasing acknowledgement of the importance of lived experience in mental health, too often survivor voices are not included.
However, survivor voices are crucial.
Our knowledge needs to be heard, understood and included in the public discourse, even though this may be challenging and difficult for some.
It is especially important at times like these when the voice of psychiatry is dominating the conversation of reform.
Author details
Grace White is a disability rights advocate and psychiatric survivor. She is completing a Master of Public Health specialising in social research at the University of New South Wales, and has particular interest in restorative justice for survivors of institutional abuse, Mad studies, public health liberation, and COVID-19.
Further reading
Beyond psychiatrists’ pay: fixing the broken foundations – Croakey Health Media
Jackson, F., Fong, T., Jones, K. & Orr, M. (2021). The lived experience workforce: The importance of respectfully embedding lived experience at all levels of service design and production. Brazilian Journal of Mental Health, Vol. 13 (36), 82-96.
Jackson, F. & Fong, T. (2017). Why not a peer worker. Mental Health and Social Inclusion, Vol. 21 (3), 176-183
Not Before Time: Lived Experience Led Justice and Repair
NSW psychiatrist mass resignations: Judges, doctors warn of ‘unacceptable risk’ to public safety
Psychiatrist accuses NSW government of ‘declaring war’ on mental health system – ABC News
See Croakey’s archive of articles on trauma and health
