What is a "crisis?" The Earth is on fire, and it's not getting any better. Is it wrong to cry, scream, or want to die in such conditions? We are all lonely, sick, and nervous. Dramatic or strange responses and behaviors may be entirely appropriate responses to an increasingly uninhabitable world. A breakdown can profoundly disrupt our or our loved ones' lives and sap our strength and energy, but they can also be opportunities for learning and growth or change. Peer support models contend that people who hear voices, see visions, or experience rapid/extreme emotional shifts are more likely to be gentle and understanding to others who do as well. This suggests that mental health issues are in part social questions, and cannot be reduced to individual factors. We need more spaces where our strangeness can be openly discussed and supported. 

When something is labelled a "mental health crisis," a central assumption is that such a person needs a "mental health solution." The problem is: these solutions are determined in advance. Having no access to housing, money, or other resources just is distressing. Why is it deemed obvious or natural that those who appear to be in distress need therapy, medication, or incarceration? It seems just as likely such a person would need money, housing, company, or food. The knee-jerk response is to offer psychotropic medications to those who seem to be "insane," but it may be just as likely that they need $1,000, lunch, or a free room. Material context adds to the understanding of crisis our real and specific conditions as inexorably tied to our physical and psychological presence without collapsing one into the other.

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"Mental health" issues are commonly treated as a purely medical problem to be dealt with by experts, but, unlike most other medical issues, the diagnosis of a mental disorder can result in incarceration, surveillance, forced treatment, and a fundamental shift in legal status. The typical civil commitment hearing lasts just a few minutes, but it can decide months to years of one's life. Mental health issues are in equal part legal determinations worked out by lawyers and judges. Patients have the right to seek out counsel or a new lawyer and push for a different treatment plan than is proposed by a psychiatrist or judge, but are rarely aware of these options. Legal process around commitment and incompetency proves that madness is not a simple medical problem but something which involves legal/political concepts of citizenship, agency, and freedom.

Modest proposals for a radical mental health

Contest Benevolence and Niceties 

A nice prison is still a prison all the same.

Decarceration of some form looks very likely. Debt, technological innovations, and political trends seem to be turning the tide against large congregate prison settings. In its wake, subtle and precise practices of control like ankle monitors, digitally regulated antipsychotics, and "therapeutic confinement" in drug treatment centers, psych wards, for-profit psychiatric hospitals, and nursing homes are likely to become more common without widespread resistance or even recognition. It is vital to recognize the violence of the state's benevolence and contest such "improvements," the result of which is to spread the logic, forms, and spaces of incarceration beyond the prison's walls. 

 

Shelter and Respite for All 

Somewhere to go when you can't go somewhere else. 

Spaces of healing and respite are sorely needed. Respite houses or centers are spaces of refuge staffed by peers for the distressed and distraught to go relax and express their emotions and thoughts. At the moment, they are few and far between despite their simplicity and efficacy. Independent social groups like the Hearing Voices Network have popped up around the country offering similar spaces of care and openness. Respites and social groups do not make money, and they are run by nonprofessionals who often do not ask those seeking connection and respite to change themselves, which means they will be resisted at every turn in the US and likely remain small and marginal. For the respite house model to offer a real radical change in mental health care in this country, respites would need to be opened and staffed by sympathetic peers in every city in the country, something which at present appears distant. How can alternative initiatives link up with larger social movements? What other places and practices can offer needed asylum to those in need?

 

Deprofessionalization, Now

It is not enough to be thoughtful or anti-authoritarian: the professionals must at some point actively destroy their power.

The experts of mental health care are legion. Laborers have flocked to care-work positions in local governments, hospitals, and treatment centers and established professional mediating positions between the traditionally upper-class psychiatrists and superintendents and the historically poor and immigrant hospital nurses or group home staff. These experts are by and large more liberal minded, but have been less involved in radical projects than the nurses and paraprofessionals who, on some occasions, have joined the patients in protest against the medical institutions themselves (rather than just one aspect). Those who want to change the system cannot simply subscribe to horizontal and anarchist repudiations of power; the scales are so uneven that only a project of self-destruction could even the playing field.