EDITION: Bad New Times.
If we are to think about alternatives to policing and prisons, we must also think critically about the mental health system’s own relationships to structures of institutional racism, violence, and the state.
The Black Lives Matter movement has brought into the mainstream calls to defund or abolish the police, as well as the prison system, in both the United States and in the UK. Shamefully derided by the Leader of the Opposition as ‘nonsense’, at their base these demands reflect an awareness of the fact that our criminal justice system does not keep us safer – that, in fact, it actively endangers Black lives – and that, as such, the sums of money invested by the state in policing (huge in the UK; astronomical in the US) might be better spent elsewhere.
As activists have patiently explained, the call to abolish the police is not a negative demand, but a constructive one. The end to policing imagined by abolitionists is not simply the elimination of existing structures, but the accompaniment and result of a thoroughgoing reimagination and democratisation of how as a society we might promote our collective security and solidarity, and realise a more comprehensive vision of social justice.
One version of this argument that has gained traction on the left in recent weeks is to argue for a reallocation of funding from police budgets into mental health services. Responding to Keir Starmer’s intervention last week, for example, the Black Lives Matter UK Twitter account wrote that, “When we say ‘Defund the police’ we mean ‘Invest in programmes that actually keep us safe like youth services, mental health and social care, education, jobs and housing.’” Others have pointed to the disparities in money currently allocated respectively to the police and mental health services, or to the massive overrepresentation of people with mental health problems in prison.
These demands are consistent with general discussions on the left around funding for mental health, which have been framed by opposition to austerity, but a simple reallocation of funds from policing to mental health provision is not necessarily the solution to the problems identified by these discussions. In positing mental health intervention as a humane alternative to our brutalising police structures, there has been a tendency to lean heavily on an idea of mental health services as we would like them to be, rather than as they actually are. If we are to think seriously about alternatives to policing, however, we must also think critically about the mental health system’s own relationships to structures of institutional racism, violence, and the state’s legitimate use of force.
Activists have rightly pointed out that, with a lack of available mental health resources in the community, people experiencing episodes of severe ill health are increasingly likely to come into contact with a police officer rather than a health professional. This is as true in the UK as it is in the United States, where a recent report estimated up to half of people killed by police have a diagnosable mental illness or learning disability. It is in this context that sociologist Adam Elliott-Cooper, who also sits on the board of the Monitoring Group, argues that:
We need to have properly trained mental health professionals that people can call if they see somebody having a mental health crisis. So that rather than the police being called, where the person’s safety is put at risk, where the police aren’t trained, and they’re more likely to use violence towards that individual, particularly if they’re Black, we can have better trained mental health services for people in our communities.
For a person in the midst of a mental health crisis, particularly if they are Black, it is usually preferable to come into contact with a mental health worker than a police officer, especially if that police officer is armed. But we should be under no illusions that a better-funded, though otherwise unreformed, mental health system would not be subject to the same systemic issues which currently characterise policing.
The intention here is not to contest or pick holes in the demands of activists who have called for the abolition of police and prisons – demands which should be supported wholeheartedly – but to extend the same kind of analysis to the mental health system. While we should welcome the ways in which abolitionist critiques have drawn attention to the structural racism, sexism, and violence which is embedded within the criminal justice system, it is vitally important that these critiques be applied also to mental health services. The alternative is to risk replacing one set of carceral, violent, and racist institutions with another; to permit the continuation of policing by other means.
In the UK, the Mental Health Act provides the state with extensive powers to restrict an individual’s liberty. Under the provisions of the Act, people deemed to be suffering from psychiatric disorders can be detained involuntarily, and in some cases indefinitely. Over the last ten years, the number of people detained in this way has increased by 47%. Unlike those caught within the criminal justice system, psychiatric patients can be incarcerated or otherwise punished without trial, indeed without a crime having been committed. Both inside hospitals and outside, using ‘community treatment orders’ (CTOs), psychiatric patients can be forced to comply with a programme of medication or treatment against their will, under threat of compulsory detention. In the last year, electroconvulsive therapy – thought by many to be a relic of a bygone age of horror-movie psychotherapy – was administered to around 1500 people in the UK without their consent.
The coercive powers of the Mental Health Act are vastly disproportionately targeted at the same ethnic minorities who face a greater risk of police violence, surveillance and harassment. Black people are four times more likely to be sectioned than white people, and nine times more likely to be subject to a CTO.
The coronavirus pandemic has lain bare existing racial inequalities within the UK’s healthcare system in general, and these are particularly acute in mental health. While racial inequalities in healthcare outcomes within the NHS to some extent map onto socioeconomic disparities they are not coextensive with them. Neither is it simply a question of access to services. Inequalities in healthcare are also a function of the way in which the ill health and suffering of ethnic minority patients are perceived by healthcare professionals. When it comes to mental health, this embedded racism means, for example, that the behaviour of a black man undergoing a psychotic episode is more likely to be perceived as violent or threatening. As a result, black men are seventeen times more likely than their white counterparts to be diagnosed with a serious mental health condition such as schizophrenia or bipolar disorder, and to face the medico-legal consequences of diagnoses associated with anti-social behaviour.
Beyond the direct coercion experienced by those at the sharp end of psychiatric intervention, we should also worry more broadly about the ideologies and norms which circulate in psychiatry and mental health provision, and the more subtle forms of control and compulsion which they might entail. As Lauren Kennedy has recently argued, the left’s focus on austerity in discussions of mental health provision – demanding more services or, more often, protesting their closure – has often unwittingly functioned to close down discussion of the logics behind these services. As such, “a failure to engage with the critical issues surrounding mental health and psychiatry risks leaving us as active participants in reproducing oppression.”
The dominant medical model of mental health locates the causes of psychological disorder within the individual, obscuring the socioeconomic and political factors – including poverty, debt, racism, sexism, homophobia and transphobia, among others – which might contribute to our alienation and distress. For most people reporting common symptoms of anxiety or depression through their GP, for example, treatment options will be limited to a choice between (or combination of) psychopharmaceutical medication (positioning symptoms as the result of chemical imbalance), or psychological treatments (overwhelmingly cognitive behavioural therapies) which attempt to transform an individual’s ‘thinking patterns’.
Such interventions are often of use – and in some cases life-saving – to people who are unwell. At a systemic level, however, the privileging of individualised regimes of treatment can also function to foreclose or delegitimise recognition of the wider contexts which produce and reproduce illness, instead promoting functionality within a dysfunctional system. In recent years, the same imperative has structured an increasing intersection of mental health services with the benefits system, whereby those living with mental health conditions face insistent pressure to “recover” and return to employment, and those who continue to receive benefits are subject to constant suspicion, harassment, and surveillance by the DWP.
If the ideologies which currently structure the mental health system remain in place, the expectation that even very generously funded services, with thoroughly trained professionals, could constitute part of an emancipatory abolitionist project is implausible. Indeed, it might seem as absurd as the assumption that better pay and training for police officers would mitigate racist violence. While a focus on mental health – understood as the individual and collective wellbeing and flourishing of our communities – must be central to any abolitionist future, this must entail a radical rethink of what mental health institutions and therapeutic interventions would look like in practice.
To see the dangers of an abolitionist project which is not accompanied by the fundamental structural and ideological work of imagining alternatives, it is necessary only to look to the history of mental healthcare itself. From the middle of the twentieth century, calls for the liberation of psychiatric inmates from the prison-like Victorian asylum system were enthusiastically co-opted by right-wing governments (particularly those of Margaret Thatcher) who saw in the project of decarceration a convenient cover for austerity measures. While the abolition of the asylum system was largely complete by the first decade of the twenty-first century, this was implemented largely without any of the alternative support put in place for those suffering from mental health problems. (The influence of successive governments’ rhetoric of ‘community care facilities’, Peter Sedgwick noted bitterly in 1982, had been “particularly remarkable when one considers that they do not, in the actual world, exist.”)1 The result is the situation we find ourselves in today, where the edifice of violence and coercion which characterised the asylum system remains standing, though largely without the need for bricks and mortar, and where former asylum buildings themselves now house luxury housing developments.
The analogy with police and prison abolition here is not direct. In the absence of asylums, the question of care for those suffering psychological distress remains pressing. Conversely, it is harder to enumerate the functions currently carried out by police forces or prisons which we would want to preserve were they no longer to exist. However, the ‘successful’ abolition of the asylum system in recent history should be a lesson to the left that we must think carefully about what we are asking for when we speak about alternatives. It would be no solution simply to bolster the existing apparatus of mental health services (or indeed those of social work, the education system, etc.), only for these services to perform the functions of police and prisons themselves. Instead, as Angela Davis puts it, we must do the work of transforming these services also into “vehicles for decarceration.” That is, “rather than try to imagine one single alternative to the existing system of incarceration, we might envision an array of alternatives that will require radical transformations of many aspects of our society.”2 An emancipation from the current system of oppressive and racist policing into a similarly oppressive and racist mental health system would be no real liberation.