Escaping iatrogenic harm: A journey into mental health service avoidance

What is known on the subject?

• Little is known about how mental health services can cause harm in ways other than medication, talking therapies, diagnosis and detention under the Mental Health Act.
• The outcomes of people who avoid seeking help from mental health services due to previous experiences of harm are not well known.

What this article adds to existing knowledge?

• I provide a first-person perspective of experiences of harm within mental health services, how this impacted my care, the long-term effects of the harm on my well-being and my ongoing experiences of avoiding mental health services.

What are the implications for mental health nursing?

• Healthcare professionals should be aware of the multitude of ways service provision can harm patients, and how, unknown to professionals, patients may create an internal understanding of how to best navigate harmful service environments.
• Healthcare professionals should have a deeper understanding of the reasons why people may choose not to engage with mental health services, and what impact this may have on them.

The recent announcement of the first ever statutory public inquiry into a UK mental health service indicates a growing recognition of iatrogenic harm in mental healthcare. Despite the potential for harm across all services and practices, restrictive practices, psychotherapy, diagnosis and psychiatric medications are often the only areas of mental healthcare given significant attention. While the topic is widely discussed in survivor communities, accounts of harm caused by the everyday workings of services, including team cultures, administrative processes and staff–patient interactions, are missing from academic literature. In this article, I describe my 10-year journey through mental health services, and how everyday practices, cultures and staff behaviour deeply impacted my ability to receive appropriate care, replicated previously traumatic environments, and damaged my mental health. Taking steps to protect myself from further harm, I self-discharged and am currently living as a ‘service-avoider’. The ongoing implications of this decision and the long-term impacts of harm are discussed.