Why mad is not bad

The psychiatric system is increasingly seen as an option for criminals trying to avoid jail. Peter Beresford says a social model of distress could be the answer

Mental health service-users are one of the biggest groups of disabled people, but how you come to be included in the category is a complex and frequently worrying business. BBC’s recent Horizon programme, How Mad Are You?, offered confirmation of how hopeless even psychiatrists are at getting their diagnoses right. Yet psychiatric diagnoses continue to mushroom in numbers and impact. Children and older people are increasingly having diagnoses attached and drugs prescribed. More and more social issues are being reinterpreted in psychiatric terms, from difficulties at school to community breakdown.

But there’s a real irony here. Mental health service-users in need of support frequently report poor conditions, lack of safety, stigma and discrimination in the psychiatric system. So what’s meant to be a helping hand at what can be terrible times may end up as an additional burden and trial.

Yet psychiatry can offer an easy option for criminal behaviour. With the increasing “psychiatrisation” of social problems in society, bad is increasingly equated with mad. Violent and abusive behaviour is reconceived as “mental disorder”, not least by offenders and their defence counsel seeking less punitive alternatives to the criminal justice system.

The effect is the increasing association of mental health service-users and distress with violence and abuse.

We have seen this with child sexual abuse being treated as a psychiatric disorder and in appalling cases like the murderer Ian Huntley, with defendants trying to use unevidenced mental health problems to avoid the penal system. This is different from those terrible cases where mental health service-users have known something was going wrong, have sought help and it hasn’t been provided in time to avoid a death or a tragedy.

All this raises some very difficult questions, such as how we can challenge this inappropriate coupling of violence and distress. But we also need to acknowledge cases where there may be complex overlaps, not least with the large number of mental health service-users who end up in prisons.

There are no easy answers. First, though, we need to raise these questions in a constructive and honest way, and recognise that there may be complicated and difficult answers. We may need to do much more to challenge the dominant, medically-based psychiatric thinking.

Psychiatry still seems to be getting things wrong. First, with people needing support, it over-focuses on the individual and fails adequately to address the social issues impacting on them – the barriers, material disadvantage and discrimination. We could really do with a social model of distress here. Second, psychiatry is increasingly extending its empire into the social world, without recognising the limitations of an individualistic and medically-based approach. We really need to hear from mental health service-users about these issues.

• Peter Beresford is professor of social policy at Brunel University, chair of Shaping Our Lives, the national user network, and a long-term user of mental health services