1. When a service user ever tries to describe the poor treatment they have received from a specific staff member, or from a particular mental health team as a whole, other mental health professionals tend to dismiss this as the service user’s over sensitivity or misinterpretation, rather than considering that the staff members may actually be being abusive. This is definitely happening on a regular basis for those diagnosed with a personality disorder. Mental Health professionals suggest that, because they work with these staff members every day and that they themselves have never witnessed, or recognised, any of the abusive behaviour described, it is therefore fair to conclude that the service user’s perception is just that – a perception. A flawed perception. Because the professionals they know and work with, are always kind to them and their other colleagues, as well as service users. They are often seen as caring, compassionate, funny and passionate about providing person centred and compassionate care. The other staff members rarely get to see, or recognise, the abusive practice that service users describe, and therefore decide that it’s not actually the truth of what is happening. A lot of abuse survivors have experienced this level of denial already – where they are disbelieved because those around them think the abuser is a kind, caring and compassionate person, who wouldn’t ever hurt a fly. This denial then leads to the suggestion that this “perception” is as a result of a problem the survivor has – that they are confused, mentally unwell or suffering with a “false memory syndrome”. If that service user has ever been abused and attempted to disclose, then they are highly likely to have encountered this level of disbelief. The behaviour of mental health professionals who refuse to accept that themselves or their colleagues are being abusive towards the service user, absolutely parallels the trauma they have already been through.
2. When a mental health service has diagnosed a service user with a personality disorder, the treatment of that person often drastically changes. Whenever service users notice these changes and attempt to describe them to mental health professionals, they are often met with a brick wall. Instead of mental health professionals acknowledging their faults, they seek to find reassurance from other services. They hope to provide “training” to other services, for example, Primary Care services, Police, A&E staff etc, in the hopes of getting every professional “on the same page” and “singing from the same hymn sheet” in order to hopefully place pressure on the service user to fall in line and “accept” that any faults within the “therapeutic relationship” between them and services, is as a result of the service user themselves. This is a form of gaslighting. A well known abusive tactic. A tactic likely used on people who have suffered trauma in the past. They go to a support service for support, only to find that they too are capable of gaslighting them. It can be a complete mindfuck. It makes the service user doubt themselves and their experiences with mental health services, in the same way that, for example – family members, often band together to make them doubt that they were even abused as a child in the first place. Gaslighting is absolutely horrible, and it should not be present within mental health services, but sadly, it is. Very much so.
3. When mental health professionals use the diagnosis of personality disorder as a tool to silence service users. This happens on a regular basis, and it definitely parallels the experiences of service users who have suffered abuse. If these service users ever try reach out for support, they are often labelled as attention seeking and manipulative, yet if they decide not to reach out for support, it is suggested that they are failing to engage with services and therefore should be discharged. This kind of treatment can make the service user feel as though there is no point in trying to ask for help, and so they try to cope with any distress themselves, rather than reach out. The diagnosis silences service users, much in the same way that abusers try to silence their victims by discrediting their experiences. The abusers often tell the victim and those around them that they are unwell and that this is why they are “saying” these things – these “lies”. But if the abuse survivor doesn’t disclose the full truth, at the “right time” or their recall isn’t as good as is expected of them from those they disclose to, then they are also accused of telling lies. Just as the service user faces criticism no matter which direction they take, the abuse survivor also faces criticism, no matter which direction they we take. These actions mainly serve to silence many service users and abuse survivors. The tactics used are scarily similar.
4. When mental health professionals take notes but fail to record them accurately, and also share things with other professionals without first obtaining informed consent from the service user. When a service user shares how they are feeling and what is going on for them with a mental health professional, this information is often recorded inaccurately within their medical records. This has parallels with how abuse survivors are treated when they try to disclose abuse, because the survivor cannot control how those they disclose to will react. They cannot control what that person will say to them, whether or not that person will believe them, or whether they will take their pain seriously. They also cannot control what that person might go on to say to others about what has been disclosed to them. Just like an abuse survivor takes a big risk in trusting someone, it soon becomes apparent that the service user has to take a big risk too when engaging with mental health services. They are forced to accept that their truth is no longer their own, because mental health professionals have the responsibility of deciding how many people get to know it. This is not informed consent. Some service users are often treated badly overall by mental health services, and abuse survivors are also often treated badly by those who minimise the abuse or refuse to believe it even happened.
5. Whenever abuse survivors have to spend time as an inpatient on a psychiatric ward, they can often end up feeling trapped. Being locked in on the ward and unable to leave without the say so of professionals involved in the survivor’s care, can make them feel like they can’t escape. This is very similar to how the abuse and the aftermath of the abuse can feel for some survivors. Control is really important for survivors, so when that control is taken away from them, it can feel really frightening and bring back so many trauma memories to the surface. If any survivor is in severe distress and ends up being restrained in the hospital, that too can trigger memories of abuse. It can feel absolutely suffocating. Every single aspect of the care received on a psychiatric ward can be triggering. The parallels between the abuse and the psychiatric ward can be incredibly overwhelming.
6. CPA meetings. These meetings, based on the Care Programme Approach, are meetings with the service user and all of the professionals deemed relevant by the service to the service user’s care. They tend to happen more frequently with inpatients rather than in the community, but they are still a prominent part of a service users experience of the care they receive. These meetings have lots of parallels with abusers and abuse. The service user is often not given the choice of having these meetings – it is something forced on to them. This kind of coercion can trigger how it might have felt in the past when they were being abused. Power, control and choice are key to abuse survivors feeling safe. If any of these things are absent, it can make things really difficult to cope with. Having several professionals sat in front of a service user, firing lots of difficult and distressing questions at them, at a time when they are likely already feeling very vulnerable, can be overwhelming. It can feel like the control has been taken away from them. It can also be incredibly frightening when considering the link between when the service announces it’s time for a CPA and the prospect of being discharged from the service altogether. The power imbalance can often be HUGE in these meetings, despite any good intentions from mental health professionals involved in these decisions.
7. Multi-Disciplinary Team meetings (MDT’s) and Team Formulation. When service users begin engaging with the support on offer from mental health services, this is seen by those services as informed consent for any future meetings between professionals to discuss their care, as well as any Formulations made. In this situation, power, control and choice are all immediately taken away from the service user. The way mental health services work, mean that it can often be way too late before a service user fully realises how far their trauma history has travelled through the system. Medical records are permanent, and so the service user also has minimal rights with regards to getting this history removed from the records. This parallels with abuse and abusers in similar ways already mentioned above, in relation to CPA meetings. The service user has interventions like Formulation forced upon them in the same way that diagnoses are. Just like with CPA meetings, the choice to say no is taken away from them. This level of coercion can trigger trauma memories. It can make the survivor feel as though they are right back in that moment, being abused and feeling frightened and overwhelmed. The power imbalance can often become way too big, making it incredibly hard for the service user to trust the people who are supposed to be helping them.
8. Time Limited Therapy. There are currently service users all across the country who are waiting on very long waiting lists just for an assessment to decide if therapy is suitable for them. If they are lucky enough to be offered therapy, it is often time limited. This means that the service user has to work fast to trust the professional enough to talk to them about their trauma history. It also means that therapy often ends far too prematurely, with Pandora’s box well and truly opened. This has parallels with abusers and abuse. For example, abuse survivors are often pressured in to reporting the abuse to the police, with them knowing full well that the adequate support to help survivors through the process does not exist. Time Limited therapy can often leave the service user feeling abandoned, much in the same way the court and legal process can leave the abuse survivor feeling abandoned. Abuse survivors should be entitled to proper trauma therapy, and the fact they aren’t is a terrible injustice, in the same way that their abusers rarely end up facing the full force of the law. Mental health services often try to pretend that time limited therapy is an adequate response to help with the aftermath of trauma, in the same way that the police and society as a whole often try to pretend that adequate support is in place for abuse survivors to go through the legal system (or just any support for survivors in general).
9. When mental health professionals exert their power by making important treatment decisions regarding any medication. More often than not, service users do not get much say in what medication may or may not be prescribed to them, or what medication they can choose to take or not take. This is yet another example that highlights the power balance in these relationships. As has already been mentioned earlier in this blog, power is incredibly important to abuse survivors. Power, control and choice. To have these taken away from survivors can be incredibly triggering, and this definitely happens in the context of mental health medication. Some service users are forced to take medication that they absolutely do not want to take. Equally, other service users are forced to come off of medication that they absolutely believe is helping them. This level of coercion can be retraumatising for abuse survivors because it can feel like someone else is hurting them and controlling major aspects of their lives, which parallels with what the abusers did to them in the past. The reluctance to prescribe PRN medication to those in crisis can also trigger trauma memories, because it can feel as though their pain is not being taken seriously (much in the same way as described earlier in this blog with regards to those diagnosed with a personality disorder). Efforts made by mental health professionals to involve service users in the decisions made regarding medication are important and recognised, but yet again, the power imbalance can be completely overwhelming.
10. Crisis Services in the community. When a service user is in crisis and needs extra levels of support, they are often told to phone their local crisis team. Unfortunately, it is well known that the responses from mental health professionals here can be far from helpful or compassionate. A great deal of emphasis is placed on the service user taking responsibility for their actions and the consequences of their actions, especially with regards to suicide. The idea of capacity is used to get people off of the phone as quickly as possible, and it can massively invalidate or minimise what the service user is going through at that time. Positive risk taking is also often used with service users in crisis. This can be incredibly harmful, despite mental health services insisting it is about helping people rather than harming them. The parallels between all of the “tactics” mentioned above, with abuse and abusers are clear. Abuse survivors often struggle with feelings of self blame and shame, and these feelings are often reinforced by mental health professionals using the tactics mentioned above. Abusers use their own tactics to make the victim feel shame and like they are to blame. So all of the similar interactions with the crisis team (or any professional from any mental health service) can easily trigger trauma memories. When Mental health professionals have to visit a service user in crisis in their home, they can often come in pairs, despite being asked politely if they could refrain from doing that. The crisis team can also frequently send out professionals of a gender that the service user requested would not visit, and either blame this on staff shortages, or just outright ignore the request. When mental health professionals ignore reasonable requests made by service users, this can make them feel incredibly uncomfortable and unsafe. Just like how they felt during the abuse they suffered in the past. When a service user is in crisis, having a mental health professional respond with kindness and compassion is incredibly helpful. The chances of this happening are small, especially if they have a diagnosis of personality disorder, and so service users often decide it is safer for them not to phone for help. This parallels how it feels for an abuse survivor to decide not to risk disclosing their abuse, because they are afraid of the response they might get.
I have written about ten examples here of the parallels between mental health services and abusers, but there are many more not mentioned here, and probably some that I myself haven’t thought of before. Feel free to add your own examples in the comments. Thanks for reading if you did ❤️