Rewriting the Narrative on Psych Ward Abuse in Journalism

Psych Ward Reviews gained a new feature in January 2017: a news article repository of staff-on-patient abuse in hospital psychiatric wards. It is an ongoing effort, both of searches and a morbid set of daily Google Alerts with phrases such as “psychiatric patient abuse.” As part of my search process, I have read over about two hundred articles so far.

One thing of note was that many of the articles on staff-on-patient abuse I found were not in major publications. They were in local news outlets or smaller magazines. And as I knew, there are many failures of psychiatric wards as a crisis care model. These failures can involve staff-on-patient abuse, suicides, ill-maintained facilities, and Medicaid fraud. My focus here is how journalists cover abuse and other failures.

Journalists do so with a few different lines of thought. Many fail to address issues that come with psychiatric wards as the main method of crisis care. These problems include taking away patients’ rights and ability to make decisions. Instead, they discuss issues such as funding and staffing shortages, and overcrowding and bed shortages. However, the reasons for psych ward abuse are power dynamics and ableism.

The system requires institutionalization in secured wards away from the public. Patients then lose their rights (available in theory). The power shifts to doctors and staff, who make decisions about a patient. Many hospitals seek patients for profit. These are settings prone to abuse. We must build a stronger network of community-based crisis care, including peer respite centers and support. There must be meaningful oversight and accountability for any community care providers.

But why don’t journalists talk about creating alternatives to psych wards? The reasoning by many journalists is that shortages result in increased abuse and neglect of patients by staff. They then describe hospital failures as inevitable because of these shortages. But the psych ward system’s issues are structural, rather than wholly solvable with money. Journalists could instead talk about these structural failures. They could do so in many ways.

They could cite the various works around abuse in institutional settings, and question power imbalances. They could push for more accountability and data on abuse rates in articles. They could interview former patients, to see what community options they want. Depending on the size of their platform, they could craft a new crisis care narrative for the broader public. The narrative would present alternatives entrenched in community-based, rights-affirming crisis care.

 

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On #WorldMentalHealthDay

In much the same way I am tired of awareness for autism, I am tired of mental health awareness. I understand that autism is different from mental health disabilities, that there are also many autistic people with mental health disabilities who dislike autism awareness but don’t mind mental health awareness. I am not one of them.

When I hear you talk about awareness for mental health disabilities, when you say, “This is a serious condition affecting this many people,” or “this many people have a mental illness!” or “we need to focus on access to care,” I hear, much like many autistics hear the same when autism awareness campaigns occur:

We are an epidemic. We are a public health crisis (and get named as such). We are only DSM diagnoses and flight risks and patients and if we’re not trying to hide ourselves we are a failure to a model that teaches us the best patients are telling their stories of how they got better to end the stigma. We are merely the rates of our mental health disabilities among people.

In fact, I would argue that only having stories of getting better hurts those people who may not get better. And why can’t we talk about issues like employment (or better benefits for those who would have a hard time working), access to housing, before access to care? Access to care, if desired, should follow meeting basic needs. It’s a little hard to focus on any sort of treatment when basic needs aren’t being met.

I am tired of awareness. Why do we have more people talking about access to hospitalization instead of peer respite care? Where are our community-based supports? Where are our warmline projects to prevent crises? Where are our self-directed services? Where are they?

Staying Silent During National Suicide Prevention Week

I watched people write posts and tweet with the hashtag with a bit of muffled, tamped-down fascination. This was my first National Suicide Prevention Week after being twice-institutionalized in one year. The hospitalizations weren’t my first times being suicidal. But National Suicide Prevention Week had always been a dull echo – mental health hotlines plastered over social media and onto the bathroom stalls at my college – much like the suicidal ideation that was constant static in my mind, sometimes flaring up like microphone feedback.

* * *

But this is not a post about my journey through suicidal ideation and tendencies.

It’s about how National Suicide Prevention Week allows society get away with mistreatment, discrimination, and other systemic factors by placing responsibility square on the suicidal individual, and then expects us to tell our suicide survival stories like we’re in a spectator sport, rather than bearing witness to society’s shortcomings.*

Yes, people with mental health needs seem disproportionately more likely to die by suicide (I looked long and hard for these suicide rates on a national scale, but only found data that “the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death,” of course without talking about societal factors). But discrimination has a negative impact on mental health, and many populations experience imbalances in suicide rates. (What I mean by societal factors are: discrimination and mistreatment – including incidents that seem small, part of everyday life, and/or seem more overt and blatant).

What’s to go wrong with preventing suicide, though? I know suicide results in lost lives. I know it hurts the living. I know there’s a reason people close to me cried when I admitted myself to the psych ward both times for suicidality. I know how they would have cried further had I actually died. I know people with mental health needs die by suicide and their deaths could have been preventable through access to certain care.

But… SAMHSA saysIdeally, these [suicide prevention] efforts address individual, relationship, community, and societal factors while promoting hope, easing access into effective treatment, encouraging connectedness, and supporting recovery.” That sounds great to most people. Parts even sound nice to me on the surface. But the “community, and societal factors” parts feel like they’re still in the “ideal” stages. One of the largest charities involved in suicide prevention, the American Foundation for Suicide Prevention (AFSP)** focused on firearms and suicide, emergency department screenings and primary health care screenings as part of their Project 2025 model for National Suicide Week Prevention 2016. None of these include factors other than individual (that match the factors I’m talking about). None of these come near addressing mistreatment, discrimination, and the like. None of these address communities often impacted by trauma and/or high rates of mental health disabilities (in part due to mistreatment and discrimination).

Mistreatment and discrimination also preclude many from seeking mental health care. As I’ve said before regarding the public conversation on mental health: “[it] doesn’t factor in the many other reasons why people might not seek care. These reasons include… forms of bigotry in health care. Medical professionals are not exempt from casual or blatant forms of bigotry.” If no one addresses causes of suicide in terms of the toll of discrimination and mistreatment on individuals and communities, it is my opinion that we will not be able to reduce suicide rates as much as we want to. Further, not addressing systemic issues allows society off the hook entirely (which is a problem I have with a lot of disability and mental health awareness campaigns).

* * *

Do I believe in suicide prevention? Yes. But I believe in comprehensive suicide prevention. Suicide prevention must encompass both the individual and society. I believe in suicide prevention that reduces the amount of discrimination and mistreatment in the mental health care system. I believe in suicide prevention that works as more general mental health advocacy to provide stable housing and community services as opposed to institutionalization and lack of in-home settings. I believe in suicide prevention that addresses whole people and their relationships and communities and the impact society has on them.

What would my vision of comprehensive suicide prevention look like? My vision would look like addressing individual needs through crisis support and preventing a crisis from even happening, but also addressing societal barriers and discrimination. It would look like 24-hour drop-in centers staffed by peer support specialists. It would look like at-home services as opposed to locking someone in a hospital. It would look like collaboratively working for many forms of lessening discrimination against various marginalized people through multiple methods of advocacy, including direct action and incremental change. It would look like supported housing and late-night cafes and be a broad approach.  

Do I believe in suicide prevention? Yes. Do I believe in this particular awareness campaign of suicide prevention? Not as much as I could. 

* * *

*I do not speak for all people with mental health needs. I do not claim to. I know some people with mental health needs find these campaigns to be enough and/or to be the most appropriate thing. My opinion differs.

**I must note that I am not, in fact, wholly against AFSP, and that I don’t want to sound like their approach will do nothing at all. I just argue that it’s not enough.

I do welcome thoughts on this blog post, but I will remind you of my comment policy.

Ableism on the Left

Here’s some things that highlight for you that ableism is not just a right-wing issue:

My friend got called the r-slur for being an ally to the mental health community and penning an opinion piece on “Stop calling Trump crazy.” The sad and terrible irony is so great I don’t know where to start. Perry noted that people attacked him “who, in theory, are on my side in many issues.” Theoretically, people on the left and people who call themselves progressive Democrats are against ableism and bigotry. Bernie Sanders said Republicans were the reason we needed mental health care as a “joke” in one of the Democratic debates. The audience laughed. But wrong does not mean crazy.

Salman Rushdie, who supported President Obama’s election and has criticized Republicans before, stated the following in an August 12 Tweet: “No, I’m backing the non-insane candidate. And Flann O’Brien would be ashamed you’re using his name.”

salman rushdie assholery

When a disability activist, DandelionGirl on Twitter, expressed that Rushdie’s tweet was distasteful and ableist, lamenting, “<sigh> another fave using ableist language. Will the mental illness stigma ever end?” he responded with the following: ““Ableist?” Oh, sorry. Trump is not insane (unfair to insane people). He’s just “differently abled.””

salman rushdie being an asshole'

Someone commented on a Facebook share about a Trump spokesperson saying something factually inaccurate about President Obama starting the war in Afghanistan. They said of Donald Trump and his spokesperson, “I wonder what mental institution he found her in and why he got her out!”

To conclude what could be an even longer list of ableist actions, the founder of the DiagnoseTrump Twitter hashtag (arguments against this presented by s.e. smith for Bustle in the link) is a Democrat. Many disabled people/people with mental health needs have spoken out against the DiagnoseTrump hashtag and pathologizing Trump, as s.e. smith did for Bustle.

I am a mentally ill, twice-institutionalized in a psych ward person. I read your posts. I read your comments. Many of us do. We all notice. We notice how much you want to blame mental illness for bigotry and believe it’s because people are sick in the head that people could say and do such things. For distance – it’s easier to not acknowledge society’s shortcomings when you can point fingers at mental illness. We notice how much you are willing to throw us under the bus to try and defeat Trump. Defeating Trump is a good cause. Using ableism to do it is unnecessary and increases stigma. It hurts people, including me. We know what you think.

Do you think that actually helps our mental health? Encourages people to reach out to others when they’re struggling? Isn’t that what you want – for us to get treatment? You want us to get treatment, and then blame bigotry on mental illness and use it as a prop to try and defeat Trump. Note that I am not advocating for us to focus on treatment in mental health advocacy – we should have the right to self-directed services if we want them.

But if that’s what you want, then openly linking bigotry to mental illness and joking about mental institutions will not help. Maybe try working to decrease the amount of bigotry in the mental health system (that does not respect racial, disabled, ethnic, gender, and sexual identities). Maybe try advocating for changing the way it involuntarily holds people in psych wards and institutions (get us more community-based services). Maybe try working to make it more affordable? Maybe try not forcing us into a broken system that treats us as unpeople. Maybe don’t talk about us like we’re the root of all evil.

I am holding the left Democrats responsible for perpetuating discrimination and stigma. Trump and and the GOP are assuredly ableist – but for the Democratic Party, a party that sets itself up as being not-Republicans and not-bigoted and more progressive, this betrays their – and society’s – ableism. I have pointed out before that even when journalism is responsible, people’s comments bring out society’s ableism. People’s comments show how little they actually think before they make such comments – or if they do think, they find it acceptable.

We don’t need to throw disabled people, and people with mental health needs, under the bus to make our points. We don’t need to do that to ensure Trump’s defeat.

Ableism is not just a right-wing issue.

Trump and the Language of Mental Health around his Bigotry

A conversation that I wasn’t entirely enamored with occurred on Twitter recently regarding Donald Trump and mental health. This was between writers, journalists, and people with mental health needs (or people who fell into more than one of those categories) who agreed that Trump “doesn’t have the temperament to be President.” They disagreed about “whether [they] needed to frame temperament-issues in terms of mental health.” David Perry wrote about this – whether it was advisable to frame Trump’s behavior through a mental health framework. He presented varying arguments from multiple sides of the discussion. Some of the arguments included, several in response to each other:

  • argument 1: not talking about Trump’s mental health would increase stigma via silence on mental health
  • argument 2: “if he were dxed would… agree with you,” and that it was the armchair diagnosis speculation and use of “insane” as insulting that bothered them.
  • argument 3: temperament isn’t the result of mental illness
  • argument 4: mental illness is not a reason to be unfit for public office
  • argument 5: Trump isn’t right in the head and not even politicians are that self-centered
  • and it went on with other points, some that could be categorized under others.

I am quite inclined to agree with Finn of Expectedly that “Wrong does not mean crazy.” Finn wrote:

Trump’s disgusting plans are not the result of a mental illness; they’re the result of deep-set, unbridled bigotry that he’s exploiting to worm his way into the White House… The Republican Party as a whole deserves to be blasted… But this isn’t about mental illness; it’s about entrenched white supremacy, racism, misogyny, homophobia, transphobia, Christian supremacy and other prejudices.
People need to stop claiming that politicians – and their supporters – whose political views differ from theirs as a sign of a mental illness, as though people can’t hold different political beliefs without considering them rationally. This stereotype also comes with the insinuation that mental illness necessarily means the lack of agency required to arrive at a reasoned political decision, which is grossly untrue.

Discussing Trump’s mental health status is kind of getting into the territory where people will use it to say that people with mental health needs can’t be effective candidates for public office if they choose to run. People are also so eager to blame bigotry on mental health needs. It helps people, in my opinion, distance themselves from the thought that they could ever be bigoted about anything (when I don’t know one person who hasn’t screwed up in that regard at least once).

So, sure, being erratic and lying a lot could be a sign of mental health needs, but that doesn’t mean it’s the reason for things like Trump being a bigot. I’d like to make the point that people with mental health needs are people with many varying viewpoints on the world so if a person with mental health needs is a bigot, I would argue that the mental health needs are most often a coincidence. I know people with mental health needs who have done less than pleasant things – even, perhaps, said hurtful things about groups of people – in the middle of any sort of episode. I have had episodes where I’ve said less than stellar things, though I don’t think I’ve ever said bigoted things because of an episode – but I think it’s too easy to write Trump off as being a delusional, pathologically lying narcissist.

Finally, I really, really don’t think that talking about it in this context will lead to less stigma. In certain contexts? Remaining silent about mental health needs absolutely can increase stigma, can result in mental health needs being the bogeyman in the closet, a family’s dark secret, you get the drift – and I also advocate for the consent of the person in question. Even though Trump is a political figure and thus invites judgment, I feel like discussing it in this context invites severe judgment on people with mental health needs. It links bigotry to mental health needs because Trump is such a bigot that if people think Trump + mental health needs, they are going to start associating mental health needs with Trump-type bigotry.

*  * *

Everyone, particularly other people with mental health needs – and especially those with particularly stigmatized diagnoses like bipolar I/II/NOS, schizophrenia, or any mental health need involving psychosis, for instance – is welcome to weigh in on this. Read the comment policy before submitting a comment; I moderate comments. 

Using People with Mental Illness as Clickbait Hurts Us

Bad articles on the problems we face can hurt and kill people. Write better.

Dear everyone, including myself: We deserve to be alive. We have the right to self-directed services and whatever works best for us. We deserve to be alive. Stay alive. Stay alive.
I have been on medication for a long time, first for ADHD, then anxiety, then depression. I have intermittently had periods of wanting to die since age 14. My most recent full-blown crisis landed me in the hospital. It was not a question for my friends whether they still wanted me alive, even as I lay bare every problem and feeling I was having. They wanted me alive.
Dear everyone, including myself: We deserve to be alive. We have the right to self-directed services and whatever works best for us. We deserve to be alive. Stay alive. Stay alive.

Evidence suggests that there is an increase in suicides following media reports of suicide, which is frequently referred to as copycat behaviour or as the Werther effect… The risk is thought to depend not only on reader characteristics,2,3 but also on media content. 35 


While the author of a certain xoJane article did not report the person’s death as a suicide, she left open the implication with a “supposedly” and the method of “supposed” death. She wrote an article that openly told us what we should do and tried to tell us how much she thought our lives were worth. It was a grim reminder of some people’s mindsets, but we do not have to bow to her desires.
With that knowledge, writers, know you are writing about people who deserved to be alive, and your audience are people who deserve to be alive, and your audience includes people who may already be prone to suicidal ideation. You are responsible for encouraging us to die if you write a sensationalized drama with explicit details. That is not a thing to take lightly or relish. It is a thing to make you hold yourselves accountable in your writing.
Dear everyone, including myself: We deserve to be alive. We have the right to self-directed services and whatever works best for us. We deserve to be alive. Stay alive. Stay alive.
What do we do instead? What do I do instead? My friend wrote on how to talk about suicide, and about taking care of ourselves and each other in advocacy-based communities, which see a lot of burnout and stress. We should demand that people write more responsibly, as per what my friend gathered information on. We should take care of each other when they don’t. I will try to stop writing so much about things when I’m off work. We should set healthy boundaries for each other but still show support.  

And writers should stop writing sensationalized dramas about mental illness, regardless of whether it’s about suicide. Writers of all kinds, this applies to you. These are our stories and our lives, and we want them respected by all, not showcased as some kind warning story, some kind of pity-narrative, some kind of revenge-story, some kind of sensationalized odd horror feature story. You can hurt people. Take some accountability. 
Dear everyone, including myself: We deserve to be alive. We have the right to self-directed services and whatever works best for us. We deserve to be alive. Stay alive. Stay alive.

People with Mental Illness Deserve to be Alive

Originally published on Medium

XoJane recently published an article about someone with schizoaffective disorder’s death being a blessing. Outrage ensued. The author’s name became anonymous. The editors of xoJane, at least temporarily, locked their Twitter profiles, then released this apology:

Screencap of: “I apologize for an article that was posted here yesterday, entitled “My Former Friend’s Death Was a Blessing.” I deeply regret the hurt that this article has caused and understand that it has perpetuated stigma and diminished the lives of people with mental illness. I am committed to immediately reviewing our vetting process to ensure that this experience has a positive influence on the ways in which we at xoJane present all women going forward. I appreciate all of you who took the time to let us know how you felt about this issue.”

I will not link to the archived version of the article right now. I would like to focus on what happens when you write about these topics like that. When you write that it’s better that people with mental health needs — especially people with particularly shunned diagnoses — die, this is what I know about you: I do not trust you with anyone. And I do not trust anyone who would post such a thing. I do not know the motivation of an editor allowing it to be posted. There are a multitude of reasons people have suggested, most of them related to increasing page hits and profit. A lot of people already think our lives have no value. They will continue to visit the page. Or, people outside the disability rights/mental health communities will not hear about it.

What happens when you write this way is a lot. It first of all tells people with mental illness — and again especially those with more shunned diagnoses — that people think we’re better off dead. It confirms some of our worst fears, our darkest, deepest worries. I do not think there is any data on this, but I suspect this way of writing about us encourages people to kill themselves.

It also presumes to know what the person with mental illness would have wanted. It presumes that we always think of ourselves as shells, better off dead, and that our suffering will always outweigh our right and desire to live. And indeed, some of us do feel that we are suffering a lot, and/or have suicidal ideation. I spent time in a hospital this January to prevent a suicide attempt! But writing that you know they’d be happy with the way they died and that being dead is better for them perpetuates in a very active way negative self-value and more fear and more, “Well, no one will miss me if I die.”

Then, it reinforces the narrative to other people, casual readers, that we are miserable, soulless unpeople. That with how uncomfortable we make people, we ought to be dead. Like I’ve mentioned in other pieces, we are at best inconvenient and uncomfortable to people. People are allowed to be uncomfortable with actions and statements, and assert boundaries — I have said awkward things to people in episodes of my cyclical mental illness and done my share of sometimes screwing up — but to capitalize off it and further the idea that we’re inherently bad and wrong and unpeople is unethical.