Voice and Agency in the Mental Health System

One of my current Uni papers is a literature paper, and we’re currently wading through the ideas of ‘voice’ (who has the ability to speak/be heard) and agency (the ability to hold and exert power). This got me thinking about these qualities in the mental health system.

The mental health system has an uneven power dynamic. The patient is ostensibly the one that treatment is centred around, however, in dealing with mental health professionals, the patient often has very little power. They are there for their voice to be heard, and their reality to be treated, but sometimes the voice of the treatment provider is allowed to take over. This results in diagnoses and treatments that are not fully explained, dismissal of patient ideas and concerns left unaddressed, and a general underlining of the patient’s subordinate position. This doesn’t always happen – many treatment providers do their best to de-emphasise the power imbalance, and treat their patients very well.

Agency, the power to take control and make decisions for one’s self, is very much lacking for mental health patients. For those in compulsory care, there are very few rights left, and treatment is forced, often without even giving them a voice. In an overworked mental health system, there’s often not a lot of time to listen to seriously ill people that often cannot communicate concisely and clearly, and so they are left out of their own treatment. This may be necessary in many cases, but the situation can be more disempowering than it needs to be due to time and patience constraints.

Even those in voluntary mental health care have very little agency. The blunt fact is that there are very few choices in community mental health. You cannot choose your providers – you roll the dice, get one assigned to you, and that’s that. It’s very rare to be able to say ‘this isn’t working, I need to work with someone else’. There simply aren’t the resources available to honour that sort of request. When it comes to treatment plans, it is not uncommon to just be told what is going to happen. Sometimes you will have some choices laid out and explained to you, with benefits and drawbacks of each, but it’s equally likely that you’ll just be told what is going to happen, and your choices are only whether to comply or not. Non-compliance gets you into a bit of hot water, which is sometimes seasoned with accusations that you’re not really trying to get better.

I’m not saying that mental health should be like Burger King, with its ‘have it your way’ ethos. What I am saying is that the voices of the mentally ill need to be heard and valued more, and that mental health patients deserve to have some say over their treatment, or at least be given an understanding of what is being done and why. Some providers do this very well, but some fall down miserably.

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