The Problem
The very systems designed to offer care often become instruments of oppression.
When we examine state-sanctioned psychological care — such as that provided by the NHS — the structural flaws become obvious. The NHS is under severe strain, with chronic underfunding and understaffing at the heart of its dysfunction. This neglect not only pushes many individuals toward private care but also reinforces a system where bureaucratic procedures take priority over genuine human needs. As a result, “care” is reduced to a checklist of protocols that frequently fail to address the deeply personal needs of those seeking healing.
If you are deemed “not sick enough,” accessing timely support can be nearly impossible. Conversely, if you are considered “sick enough,” the treatments you receive may feel more like punishment than care.
This reflects a broader, troubling trend in the UK, where state structures are growing increasingly authoritarian. The focus of care shifts from prioritising individual wellbeing to enforcing compliance. Psychological services, intended to be a source of healing, often become tools of social control. Marginalised communities bear the brunt of this approach: in the UK, being Black or from a refugee background nearly doubles the risk of involuntary hospitalisation. These coercive treatments are not just failures of care but active contributors to ongoing oppression.
The Paradox
Although state-provided services are deeply flawed, many people have no choice but to rely on them. Completely rejecting these services is often not an option, especially for those who cannot afford private care or access community alternatives. It is this inescapable reliance on flawed systems that creates an unsettling reality: the institutions you turn to for help may ultimately cause harm instead.
One clear example of this contradiction is the system’s over-reliance on medication, particularly SSRIs, as a default treatment. While medication can be necessary and helpful, treating it as a one-size-fits-all solution often overlooks the deeper causes of distress. Addressing these would require challenging the social and structural systems that maintain inequality — something that threatens those who benefit from the status quo. By focusing on managing isolated cases of “dysfunction”, the need for social change is conveniently deferred.
As someone with “complex needs”, I had been prescribed almost every antidepressant available by the time I was 18. I knew that antidepressants weren’t helpful for me, but when I expressed this, my insights were dismissed. Instead, I was given more SSRIs, which caused both short and long-term iatrogenic harm.
Similarly, I was involuntarily hospitalised more than five times in a single year as a minor. When faced with yet another hospitalisation, I expressed my reluctance to return to the same unit, as it had been ineffective, if not harmful, every time before. I suggested alternatives that I thought could actually help ease my distress. My concerns were dismissed, and, facing another forced admission, I ran away. This left me temporarily homeless. I learned to distrust mental health staff and to avoid seeking support through state-sanctioned channels, fearing that I might end up incarcerated and drugged against my will.
True care cannot involve force. Every individual — even those considered the most “complex” — possesses a deep understanding of their own needs. To ignore this is to deny their humanity.
In focusing on managing symptoms rather than addressing the underlying factors — such as trauma, inequality, or systemic injustice — that contribute to psychological distress, the system becomes complicit in maintaining the status quo. Navigating a system that is both a lifeline and a source of harm presents a profound challenge. This paradox underscores the urgent need for a complete reassessment of how psychological care is provided and experienced.
What’s Next?
Exploring alternatives rooted in justice and human dignity becomes essential. While it is difficult to completely move away from state-dependent resources, community-based models offer a more compassionate approach.
Grassroots initiatives and peer support networks focus on relational care, offering personalised support based on mutual respect and shared experiences. These models reject the hierarchical, punitive methods of state-provided care, instead prioritising trust and individual autonomy. Judi Chamberlin advocated for these principles over 40 years ago, promoting patient-controlled care where patients are not just passive recipients of care but active contributors to their own healing. Her ideas remain relevant now more than ever.
Supporting this view, Angela Davis and Mariame Kaba’s abolitionist frameworks offer a broader perspective on why transformative approaches are necessary across institutions. They argue that true freedom and justice cannot be achieved while oppressive systems remain in place. Their work highlights that for care to be truly liberating, we must rethink and reshape our institutions.
The state-provided psychological care, with its roots in control and compliance, exemplifies the kind of oppressive institution that must be reimagined from the ground up. Reform is not enough; what is needed is a complete reframing of what “care” truly means in a just society.
Mental Healthcare in a Failing State
This blog is part of our new series, “Mental Healthcare in a Failing State”. All the blogs in the series, when published, will be added here.