We rarely talk about what happens after we do reach out, or what that care actually looks like. In my experience, some practices in our mental health system, particularly our psychiatric inpatient system, are both deeply harmful and disempowering. We don’t normally hear about them.

We don’t hear about people being forced to have an IUD. We do not hear about people being prevented from having access to their own money. We don’t hear about women be forced to attend clinics and therapy against their will. 

It happens every day, right here in Ireland, but rarely makes news. We only know about Britney, because she is Britney. We don’t know about the other people who experience numerous human rights abuses as part of a ‘treatment plan’.

I have spent long periods of time inside psychiatric wards. Since I was 14, I have experienced long periods of suicidality, self-harm and depression and have spent over ten years in both the psychiatric outpatient and inpatient system. 

I’ve been an inpatient in different parts of Ireland and have had many different cocktails of therapies, professionals and medications involved in my mental health. 

Looking back on my treatment, it is clear that in signing the papers to be admitted, I signed over ownership of my body, of my life, of my health to professionals. They made decisions for me, and my voice didn’t count.

The decision that are made for people are wide-ranging. Forced medication is a significant issue. Medication which can be forcibly injected if I refuse to take it myself.

Forced medication is a very common practice in our psychiatric system. There are many valid reasons why someone does not want to take a particular medication. These refusals are very often brutally disregarded.

I have had all of my clothes and belongings taken away from me at days at a time. I’ve been strip-searched; and forced to wear a special gown with nothing on underneath for days at a time in a busy ward.

All of these measures are acted on ‘for our own safety’ a common phrase for every inpatient. They hear it on a regular basis when their power is taken away. This is happening to Britney Spears, who is denied control of her life ‘for her own safety and best interests.

All of these abuses are presented to us patients as care.

Britney is being forced to do things, or not do things, under the very same guise of care. We must be very clear about it, this is not care, it is punishment. 

It is a result of a disempowering system. The system overpowers patients and our right to decide what happens to our bodies. We are rarely active participants in our own care plans.

 These plans are very often handed to us without our involvement in the creation of the treatment goals.

People have commented on how Britney has never spoken out before. She says she did not because she did not know that she could.

She felt that she wouldn’t be listened to if she spoke out. As patients, we don’t have the opportunity to have our voices heard, and our experiences are lost.

I understand why Britney never spoke out. Self-advocacy is incredibly difficult when you are in a system. You feel that if you speak out or refuse things, your ‘treatment’ will get a lot worse. 

So many patients never speak out or get to have their voice and concerns meaningfully heard by the people who can change things. They fear retribution. 

This creates a culture of patient passivity. The system values obedience. This is why we often quietly accept harmful and traumatic responses to our distress within mental health systems.

The Britney story isn’t a case of a bad guardian – it is a systemic problem. It is a result of the paternalistic way we respond to people in emotional distress. 

We don’t respond with compassion and understanding, instead remove a person’s power to decide what happens next. Changing Britney’s guardian will make little difference in her life. 

It could potentially make it worse if someone who does not know her will and preferences is making intimate decisions about her life.

We need to critically analyze as a society how we react to people in emotional distress and find ways to respond with care that does not erode the human rights or humanity of the patient.

Ireland has come a long way in how we treat people in the mental health system, but we still have work to do. We can start by listening to those who have experience in these systems. 

We must create environments where we, as people with experience of emotional distress, can ask for what we need, without fear of retribution. Patients must be partners. 

Only by working together in partnership with our mental health teams can we reach a place of recovery. 

Forceful paternalism is not care.