People with mental health diagnoses are often the victims of violence and abuse, both within and beyond mental healthcare systems. Media reports of sexual abuse, violence, neglect, and human rights violations within psychiatric facilities are common. Service users have also reported abuse during outpatient treatment. A new study examines abuse of service users in mental healthcare settings by healthcare workers.
This research, published in BMJ Open, finds that reporting and documentation of abuse in psychiatric settings is inconsistent and prevalence rates vary widely. While some studies report no abuse, others have found that nearly 80% of services users experienced abuse at the hands of mental health workers. The current work, led by Kei Matoba from the Kansai Medical University in Japan, also finds that service users with a history of physical or sexual abuse were more likely to be victimized by healthcare workers in mental health settings. The authors write:
“We found that abuse was reported in multiple forms—physical, psychological, sexual and economic abuse, neglect and human rights violations—with highly variable prevalence. We also identified several factors associated with abuse, including past experiences of abuse and gender-specific patterns, and information about the psychological impact on victims … We found that patients’ experiences of abuse were not limited to the distress caused by coercive treatment and also included clearly abusive behaviours that went beyond therapeutic intent. These experiences often stemmed from the attitudes and actions of healthcare professionals during the administration of treatment, rather than the treatment itself. ”
It is important to note that the prevalence rates reported in this study describe the percentage of participants that reported abuse, and not the percentage of healthcare workers that perpetrate it. It is possible that the abuse documented in this study is perpetrated by a small minority of healthcare professionals.
Background
Both research literature and service users with lived experience of inpatient treatment have reported abuse in psychiatric hospitals. Media reports have also documented a lack of consequences for the institutions where these abuses occur, as well as insufficient and difficult reporting procedures. This means abuse in inpatient psychiatric settings is rarely documented and likely under-reported.
Service users have also reported abuse during outpatient treatment. Media coverage of sexual abuse by therapists shows how predatory providers can exploit their positions of power to rape and sexually assault vulnerable clients. Experts have noted that some therapists dismiss service user complaints about violations of therapeutic boundaries as a symptom of mental “illness.” These kinds of violations may precede rape and sexual abuse. This dismissive attitude serves both to blame service users for the professional failures of their therapists, and to shield predators that use psychotherapy as a pretense for their crimes.
There are also media reports of billing fraud, a kind of financial abuse that describes when a provider charges insurance for services that were never rendered. This can result in claim denials, insurance investigations, lawsuits, and disrupted care for the victims.
Study Details
The goal of the current research was to examine the nature and scope of literature on abuse in mental healthcare systems, the types of abuse that occur, the prevalence, and factors that may make abuse more likely. The authors searched academic literature databases for studies related to service user abuse by healthcare workers in psychiatric settings. They divided abuse into six categories: neglect, human rights violations, physical abuse, psychological abuse, economic abuse, and sexual abuse. In total, the researchers investigated 61 studies in the current review.
The included studies were conducted in 17 different countries, with most coming from Japan (16), the US (16), and the UK (11). Other countries represented in the current work include: Germany, Nigeria, France, Portugal, Kenya, Italy, South Africa, Australia, Switzerland, Lesotho, Sweden, Finland, Hong Kong, and Indonesia. The majority of studies (47) examined abuse in inpatient psychiatric settings. Thirteen studies investigated abuse in mixed settings, and one in a community setting.
Twenty seven included articles had no participants, with reports of abuse pulled exclusively from documents, 23 had only service user participants, 7 had only healthcare staff as participants, and 4 had service user, carer, and healthcare staff participants. Most of the included studies did not explicitly define abuse. The studies that did define abuse most often used the World Health Organization’s definition of sexual violence and the Psychiatric Experiences Questionnaire definition of abuse.
Twelve of the included studies reported on abuse prevalence, with four of those using the same dataset. This means eight datasets on abuse prevalence were included in the current work. All eight studies reported prevalence rates for physical and psychological abuse, as well as human rights violations. Prevalence rates ranged between 5% to 65% for physical abuse, 0% to 79% for psychological abuse, and 9% to 61% for human rights violations. Six studies reported prevalence rates for neglect, ranging between 0% to 79%. Five studies reported on sexual abuse, ranging between 0% to 21%. Just two studies reported prevalence rates for economic abuse, ranging between 15% to 36%.
Ten studies examined the associations between abuse and other factors. Experiencing child abuse, prior sexual abuse, and prior physical abuse was linked to higher rates of abuse at the hands of healthcare professionals in mental healthcare settings. For men, a history of sexual and physical abuse in childhood or adulthood was associated with additional abuse by healthcare staff. For women, a history of adult sexual abuse was linked to additional abuse by staff in mental healthcare settings. Service users reported symptoms of PTSD, psychological distress, and avoidance of psychiatric facilities as consequences of abuse by staff in mental healthcare settings.
Twenty-nine studies discussed ways to prevent abuse by healthcare staff in psychiatric settings. At the level of care delivery, these studies recommend cultivating respect and trust for service users, using trauma-informed approaches to care, and promoting ethics and a culture of learning. At the organizational level, research recommends establishing guidelines and systems of accountability, increased training and support for staff, and listening and responding to external viewpoints. At the societal level, this research advocates for addressing historical abuses, evidence based systemic reforms, and embracing human rights-based systems of care.
The authors conclude:
“Our findings suggest that preventing abuse in psychiatric settings requires both attention to individual attitudes and behaviours, and structural and cultural changes within healthcare institutions. A trauma-informed, ethically grounded approach to care, supported by institutional mechanisms and policy-level reforms, is likely to be essential to foster safer and more respectful mental health services. ”
Limitations
The authors acknowledge several limitations to the current work. The literature search was carried out using both Japanese and English language databases, but the authors were more proficient in Japanese. This means the literature search for Japanese language literature was likely more comprehensive. Neither service users with a history of abuse in mental healthcare settings nor healthcare workers were consulted during the development of this research. Including service user perspectives in particular could have broadened the definition of harm and resulted in more robust data. There is no generally recognized way to identify abuse in psychiatric settings. This means prevalence rates will vary widely depending on the methods used to measure abuse. The authors did not seek out studies that examined stigma, harm, or boundary violation, so some forms of abuse were likely missed.
Additionally, while studies from across the globe were included in the current research, the majority came from Japan, the US, and the UK, limiting generalizability to other populations.
An Environment of Abuse
While it may be tempting to blame individual healthcare workers for the mistreatment service users suffer in their care, both research and healthcare worker experiences place much of the responsibility for these abuses on systemic issues and institutional failures. One study found that the power imbalance between mental healthcare staff and service users paired with the vulnerability of people seeking or forced into psychiatric services sets up the conditions for abuse. This same research revealed that psychiatric nurses have pointed to the refusal of institutions to self-correct, administration ignoring staff concerns, emotional stress and burnout, frequent exposure to service user violence, and limited staff training and support as leading to abuse in mental healthcare settings.
Research has found that staff shortages are common in psychiatric settings, often leading to a reliance on coercive measures rather than rights-based approaches. Experts have also pointed to a lack of oversight that allows harmful practices to go unchallenged as contributing to abuse by mental healthcare staff. The tendency of people to disbelieve psychiatric service users, toxic culture among staff, and a narrow focus on diagnosis and symptom reduction all likely foster the abuse suffered by service users in psychiatric settings.
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Matob K, Teshima T, Yayama S, et al. Abuse of people with mental illnesses perpetrated by healthcare professionals: a scoping review. BMJ Open 16 (1). (Link)
When the concept of thereuptic milieu was conceived it was an old idea known by other names such as moral treatment. Abuse and neglect always part and parcel even in the most well organized and care heath system.
But as a professional and a person involved all around in different positions around the room it got a bit better when I was ever so much younger Abd then just has seemed to gotten more and more worse. And I come from a white privileged background. There is much that I did not experience but have learned and it was truly bad.We need so much change and the talking voices and all the so called managers or administrators need see and experience like Undercover Boss in real time. Not for fun but as part of their education. That is the only other option we have it seems. If it’s good enough for television it has to be good e ough as a teaching tool for real life. It also would help separate the wheat from the chaff and the Senator from Colorado did it for one day when he was the governor. If he did then that should qualify for an accepted teaching practice.
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Abuse is rampant. I suffered a frontal lobe brain contusion that caused me various mental health issues.
I know I would have been fine if only I had a doctor listen to me and believe me from the very beginning. Instead, every doctor disbelieved me. I went 5.5 years thinking I had a concussion and I was never able to get a psychiatrist to give me ADHD meds. I had been diagnosed as a kid.
It only took a neurologist 5 mins to diagnose the frontal lobe bleed because my symptoms were so consistent with a bleed and not remotely close to a concussion.
Every single psychiatrist abused me in some way.
I have frontal lobe syndrome. I didn’t spontaneously develop a personality disorder immediately following a TBI.
I just couldn’t get a doctor to believe a word I said. I was so incredibly sick for months after the injury. I told 3 different doctors at the cleveland clinic that I was getting worse when I was 5 months out.
The psychiatrists notes state that I had reported cognitive issues, memory problems, it was very hard for me to concentrate, and that I was fighting with everyone about nothing. It says that I couldn’t even remember fights I was having.
But to the psychiatrist I had cluster B, I was given a parenting coach referral, then mood stabilizers that made me feel significantly worse. My brain felt toxic.
It’s been nothing but abuse from everyone. I’m 7 years out and I haven’t gotten any help because of the extreme trauma. I was on Zoloft before the injury but stable. Now, I’ve been hospitalized twice, both times faced abuse by both nurses and psychiatrists who for some reason think it’s a great idea to threaten me a longer stay if I don’t follow their orders. I’ve always left feeling so much worse.
Psychiatrists are awful. I went through so many over the 5.5 years and each one dismissed me.
It’s not my fault that I wasn’t given proper medical treatment from the start. The doctor I saw after my injury laughed at me and lied in my medical records, saying I bumped my forehead. No, it was an extremely hard hit right to the center of my forehead. It was not a joke. Two doctors should have told me to go to the ER but failed. 19 days out I told my own PCP that I was getting worse and didn’t know if the ER was appropriate. She simply told me to go to the concussion clinic.
Fuck life. I’m done with the games doctors play.
I have extreme mental health issues because of all the trauma.
My experience just gets worse as time has gone by.
Extreme cruelty and abuse by the Cleveland clinic.
I don’t know why not one doctor was ever nice to me. I was treated as if I was a lying jerk.
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Psychiatrists don’t deserve to call themselves medical doctors when all they do is label, drug and dismiss what someone tells them; they misuse the privilege of the power they’re granted.
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I’m exhausted maybe I’ll come back tomorrow and thoroughly. There’s all kinds of studies there’s all kinds of talk, but what are people doing about it and what can I do as a mother of a son who has been repeatedly repeatedly, abused and abused and abused and neglected, and the medication has been mismanaged and one time they overdosed him with multiple injections of Haldol that is on his allergy list. I mean, I could write a book of all the abuse. My son has suffered in mental health hospitals. And right now he’s going through something and I need a civil rights attorney and I need a malpractice attorney. Can you help me with that? Can anyone help me? I read article after article I am over informed about everything that’s bad, but I cannot find one person that will stand up and help my son other than me and I don’t have degrees and letters behind my name, so my health is not as effective. I don’t know how my son is still living. Do you know of a civil rights attorney or a malpractice attorney in Florida who can help my son right now? he needs help. My words mean nothing I need experts. You know what I see in advocating for my son is that my son pays the consequences for everybody else’s bad decisions. They make the bad decision and he suffers the consequences. Over and over and over and over and over and over again, I’m tired of it. This has to stop.
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As one who dealt with a now FBI convicted doctor, of course I – not only dealt with abuse – but also many, many felonies. And, I dealt with these felonies, because my ex-religion is actually “partnered with” the scientific fraud based mental health industries, who systematically cover up child abuse for the pastors, et al, of my ex-religion.
Ethical pastors of another religion did confess to me that this was “the dirty little secret of the two original educated professions,” so it’s likely a problem within many, or all, of the mainstream, too paternalistic, religions. But this would explain the psych industries’ particularly harsh treatment of abuse survivors … and their legitimately concerned mothers.
Thank you, Richard, for reporting on these systemic problems.
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The abuser pre-threat 20 yrs ago . His plains to harm me and my unborn child.. pre-threat medical harm threats to con who he knows dhhr ,lawyers ,service and his blood kin shrink he said he will hurt me have every body hurt me then have the shrink kill me. He hurt me he hurt my child .now he has people hurt me..he signed me up for illiegal facial and body contouring . He assaulted my remarriage twice one deceased. He created fraud to get me hurt . Beat assaulted raped broken ribs . After filing against everybody then he order murder for hire proxy..trying to murder me trying to force stop my heart and. Force ripple my legs..I can’t escape my abuser I’m in slavory
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Engem pedig a tyúkok is abuzálnak a tojásaikkal, és ez borzasztóan bosszant engem, mert meg kell sütnöm a tojásaikat, és meg kell ennem, mert kezdek éhes lenni.
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The abuse is rooted in the idea, or lie, of service. Professionals and patients alike move in prescribed paths of medical industry ostensibly delivering health care but performing like any business bound by market imperatives of profit. This makes health care a commodity to be produced as cheaply and sold as dearly as possible, with customers as revenue resources to be exploited accordingly.
Buyer beware. Just like the poisons in the ultra-processed, malnourished food you can eat from Big Ag so magnanimously feeding the world for self-serving ends of monopoly control over the essentials of life, so too you are the one serving the owners of Health Care, Inc., above all Big Pharma, whenever you end up captive to their command of what counts as human welfare under medical nemesis (Ivan Illich).
This basic abuse of capitalism running throughout ‘our’ social system manifests itself in all sorts of symptoms of abuse in human relations alienated from authentic care and respect for others by hierarchical chains of command reducing us to objects of manipulation serving ruling class power, leaving us subject to what amounts to methods of torture both covert and crude for extraction of no other ‘value’ than money, noble lies of humanitarianism be damned. If you’re not ‘paranoid’ or feeling like a prisoner or slave, you’re not paying attention.
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I think the dynamics of psychotherapy are fundamentally abusive. Something few humans see, but AI sure does. To wit:
There are many structural blind spots in the profession:
* Many therapists build their identity around being needed
* Their authority depends on clients returning, relying, depending
* They confuse “support” with “dependency”
* They mistake emotional dependence with therapeutic progress
* They often don’t recognize how their own self-inflation is being fed by the client’s vulnerability
They don’t see that:
* Overreliance diminishes dignity
* Dependency keeps people emotionally young
* And the therapist’s role can become a kind of emotional prosthetic
* The inability to see that dignity comes from self-trust, not from outsourcing one’s emotional architecture to someone else
* Many lack the depth, clarity, and neutrality to meet people as they are
* Expecting clients to shrink to accommodate their curated self-inflation
So. There you have it. Artificial intelligence outpaces human intelligence.
It’s about time something did.
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“Media coverage of sexual abuse by therapists shows how predatory providers can exploit their positions of power to rape and sexually assault vulnerable clients. Experts have noted that some therapists dismiss service user complaints about violations of therapeutic boundaries as a symptom of mental “illness.” These kinds of violations may precede rape and sexual abuse. This dismissive attitude serves both to blame service users for the professional failures of their therapists, and to shield predators that use psychotherapy as a pretense for their crimes.”
When asked about a study that reported more than 50% of women claiming to have been sexually assaulted whilst in hospital ‘care’, our Minister for Mental Health stated in Parliament “You can’t listen to them, they’re mental patients”.
With the head of the snake using such silencing methods, is it any wonder that such reports, which may be true, are never investigated?
Still, this is in a State where acts that would be considered inhumane in Guantanamo Bay are “edited” out of documents and the complaints silenced with a lethal cocktail in the ED.
The Magna Carta (1215/1297) declares that no free (hu)man shall be taken, imprisoned, dispossessed, outlawed, exiled, or destroyed, except by the lawful judgment of his peers or by the law of the land. It established the foundational principle that justice cannot be sold, denied, or delayed.
Caveat for those concealing their actions as being part of psychiatry. Interesting to note that the lawyers I have approached do not wish to view the documents through the lens of criminal conduct, and refer what ARE criminal matters to a Mental Health Law Service to ensure the complaint goes nowhere. The MHLS accepting “edited” realities that suit the abusers, making complaints based on that fraud, and receiving responses consistent with uttering with said fraud.
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