dreaming of non-carceral psychiatric care (musings nine years on)

At twenty-four, I am able to see the power structures so clearly in ways that fifteen year old me was feeling but couldn’t unpick.

Dec 02, 2024

Trigger & content warnings: psychiatric care, violence, racism, ableism, police, iatrogenic harm.

Nine years ago today I was admitted to a psychiatric unit for teenagers, two weeks after two doctors I had never met before deemed it necessary.

I become more radical in my position against the carceral psychiatric system almost every single day. At twenty-four, I am able to see the power structures so clearly in ways that fifteen year old me was feeling but couldn’t unpick.

Four years ago, an angry, traumatised nineteen year old version of me began to work in lived experience work within the system. I pushed against walls harder than I have ever pushed, experienced conflict and retraumatisation and being patronised by professionals who believed that I should not be in the room. My career has been built on a system that I no longer believe to be broken, I believe it to have been built that way intentionally.

You cannot fix something that is not broken; if something was built that way, it is deeply rooted, fixed in its position, its foundation strong and unmovable.

Psychiatry, and particularly carceral care, is deeply violent and oppressive. It uses every inch of power it has over you and drives you into believing you have nothing, are nothing. Your autonomy is taken piece by piece, leaving you without it even once you break free of the environment itself.

My admission was arguably short, in comparison to many of my peers - three months. But those three months changed the trajectory of my whole life since. It has impacted every single part of how I walk the world and how I interact with people, with systems, even with - maybe especially with - the people I love.

Nine years later, I find myself still traumatised, still deeply detached from my sense of self and believing I do not deserve good; being unable to give up an inch of control just in case all of it is taken away from me again.

I struggle to call myself a “psychiatric survivor”, because it feels like I got off lightly. Shorter time, less violence. And yet, the way I dissociate, the way I flashback to specific moments; the panic that rises in my throat when I feel even slightly threatened. All of it is indicative of the PTSD I have been left with.

I may never process the fact that I was a child - taken from my home, my safety, my possessions, because there were apparently no other options. This violent an intervention when I was a child.

As I write, my throat is tight. I feel like I am fifteen again and losing all control. Like my possessions are being ripped through as they search, so much of what I needed to hold close being taken from me; all sense of safety being taken within the first half an hour of living there.

And I say “living there” with emphasis - you are living there, that is your home for however long you are held there. When home is unsafe and you are constantly waiting for something to snap, even in the calm moments - there is no feeling quite like that.

I was admitted ‘informally’ - “with consent”. But we had no information, no notion of what this would mean, not even a leaflet. For the two weeks between the decision and my admission, I spent my nights googling psychiatric hospitals trying to get a semblance of what this would look like, what I was about to go through. There was little to no information, and what there was never would have prepared me.

And whilst I was not sectioned under the Mental Health Act, it was clear that if I tried to leave, I likely would have been sectioned and told I didn’t have the right mind to make such a decision.

I wonder if that can ever truly be considered consent.

My autism diagnosis came partway into my admission, a shock to no-one. Autistic people are seemingly more likely to end up in psychiatric care, representing an anecdotal 60% of CAMHS inpatients1, and having an average stay of 4.8 years2. We are held where we do not fit into the system, where it is still impossible for us to fit. People believe we saw the end of institutionalisation of autistic people and people with learning disabilities with the end of asylums, but it is abundantly clear many are falling into the psychiatric system instead.

The carceral system in the UK goes hand in hand with austerity. There is no funding for preventative care, nor are there respites, crisis cafes, peer support, anywhere for families to go and get support.

Black people are more likely to see their mental health criminalised, and are still nearly 3.5 times more likely to detained under the MHA in the year up to March 20233. Even with the introduction of the Mental Health Units (Use of Force) Act in 2018, sparked by the horrific death of Seni Lewis4, we still see large amounts of force used in psychiatric care, and this is experienced more highly by populations like Black or autistic people. The system is deeply intertwined with every form of oppression in ways that it is not ready, not able, to undo.

I dream of more. I dream of mutual aid and places that are truly safe, therapy that is anti-colonial and neurodivergent friendly; money in the right hands and our worth not being aligned with our productivity alone. I long for deinstitutionalisation and decriminialisation in ways the system is nowhere near. I want us to be depathologised and no longer simply at the mercy of the DSM5.

In her book Radical Intimacy, Sophie K Rosa says ‘imagining that things could be radically different can be a way to reject the exploitation, oppression and violence in the world, helping us to reimagine ourselves as capable of rebellion’6. This is a summary of my desire, to push back in ways that the system is not ready for - and more than not ready for, but that it does not desire.

The Mental Health Act is currently up for reform, but the reform is not radical. It is supposedly a ‘once in a generation’7 change, but I refuse to believe in the change in provides being enough, being the end of the shifts that must occur8.

As time goes on, we see aspects of the system become more oppressive, not less. Technology such as Oxevision leaves psychiatric patients being under constant video surveillance9, whilst the NHS refused to stand up against Serenity Integrated Mentoring after working with the StopSIM coalition for months and years10 - forcing Mad and Neurodivergent people to interact with the police when in distress, deeply criminalising mental health and Madness.

It is not enough, none of it is. I navigate the world knowing that what I experienced is experienced by thousands of others, many more harshly, more deeply, as the system tells people it is just keeping us safe, that it is helping us recover.

Whether these are lies, or what the system truly believes, is up for debate. Perhaps it does not matter either way.

In her book Mad World, Micha Frazer-Carroll writes in her conclusion that ‘a liberated future, for mental health, will always be nuanced, contradictory, plural and relentlessly tailored to each and every individual’11. Perhaps there is a beauty in this that we may one day get to truly explore, in a world where we are not simply living for survival and clawing back against a system that holds us still as we kick, allowing us no room for movement.

For now, I sit with myself. This dissociated, traumatised version of me who never got to find out who they could become without this experience, who is done working within a system that does not feel like it can be changed.

And I dream. I read liberation work, and I dream. I do more grassroots work, and I dream. I learn, and I dream.

Untangling with Charli Clement

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