Do no harm. This is the mantra that we are told doctors are taught and must obey. This is what is assumed to be the underlying principle of health care generally. It does not, however, seem to be part of the standards for mental health and crisis care. In Ontario I have witnessed, experienced, and been told repeatedly by many people I work with that the systems that are intended to help are, in fact doing harm.
What does this harm look like?
For trans people, it is often not recognizing the person’s pronouns, name, or even the fact that they are trans. “You can’t possibly be trans because” followed by any one of a number of things, Autistic, have Disassociative Identity Disorder, or other mental health challenge happening.
More often than not, however, it is because they do not listen to the person they are supposed to be helping. The person hears a few words then jumps to a conclusion. They expect everyone to fall into a flowchart of care that they have in their mind, or sometimes even on paper or screen. If the person says X do Y else do Z. People rarely conform to flowcharts like that.
Sometimes it comes from a desire to “fix” the person. Cure them of whatever problem might be presenting itself. I have noticed that this often comes from those trained as doctors, social workers or psychologists. The person providing the service is imposing their idea of what is right for someeone onto the person seeking help.
Why do people cause more harm?
Frequently, it is a matter of not being well enough informed. This is particularly true when dealing with LGBTQIA+ and especially trans and non-binary people, disabled people, people with disabilities, and those with long-term suicidal ideation. Providers do not receive the necessary education in school, or in their continuing education. This can result in the person not knowing how to deal with a situation that surprises, shocks, and/or makes them uncomfortable. Showing obvious discomfort can invalidate the person being helped.
Other times it is because the person’s way of doing things is the only way and they are bound and determined to force that way of doing things on the person they are supposed to be helping. Anything that imposes on the methodology and framework that they have is to be denied and pushed aside. Even when it comes from the person’s lived experience and self-knowledge.
One example of causing more harm that I have encountered is around Cognitive Behavioural Therapy, or CBT for short. This is not to be confused with the BDSM term. CBT is the go-to treatment for depression and many other things. It is the go-to because for many it is effective. It doesn’t work for me at this point. I know the techniques, but need something different for long-term effectiveness. I have, all too often, encountered people who don’t know what to do when I tell them that CBT is not the right option for me. Seeking help is difficult enough without people imposing their way of doing things.
There are many other reasons people cause more harm when they are supposed to be helping. Occasionally it is because the person really shouldn’t be doing work that is supposed to help others. They are assholes and use their power to abuse others. This happens more often than it should.
What can be done as someone seeking help?
As someone seeking services remember that if a provider is doing more harm there is nothing wrong with seeking another provider. Unfortunately, sometimes there are no other providers, or the system requires one to use a specific provider. This is particularly true for those living in poverty, are on disability or social assistance. Seeking other providers takes energy, too. Energy that one likely does not have when dealing with bullshit providers and struggling with a crisis.
Having a support network. A good support network is invaluable. At the same time it can be difficult to build a support network. Often those who are the most supportive are also people dealing with a lot of crap themselves and can’t always be there.
Know that sometimes doing the work one needs to do is difficult. It can feel like a lot of harm is being done to one while in the process. Figure out what is harm, and what is just part of the work of healing. Healing often hurts. It’s usually fairly easy to tell which is which. When a provider is being an insensitive asshole, it’s pretty obvious. This is where having a trusted support network can help. Others can often provide validating feedback that helps frame a situation.
When treated poorly, and if one has the energy, fill out or file a complaint. This is not always possible. Only if one has the energy and can go through the process is this appropriate.
What should providers do?
Education. This falls on agencies and individuals providing services. Ensure you and those you work with are properly educated and regularly update their skillset. It is not up to those of us seeking services to educate you! When I am providing support and help for others I have to do my own homework on what people are dealing with. That way, when I am in the moment and helping, I can hear what their specifics are. Sometimes this means educating oneself after the appointment or phone call.
Do not rely on the person to educate you. Somone in crisis should not be expected to be an educator. It is your job to educate yourself and seek out strange new learning, to boldly learn where you have never learned before.
Get over yourself. Make sure you are not suffering from cranial-rectal inversion. Do not assume you know it all, or your way is right. All too often this is the root cause of doing more harm.
Listen. Truly listen to what the person is saying and respond appropriately. When someone is talking about their lived experiences do not invalidate them or say that what they have experienced couldn’t have happend. This is a good way to turn the person off. Instead, validate what they are saying and work to not do whatever it is yourself.
Work to improve systems. Systems are, more often than not, dehumanizing to the person seeking help and/or needing support. Ask yourself what you can do to improve the system and your role in perpetuating problems that promote preconceptions.
We can all do better, we must do better. We will make mistakes along the way. Strive to do better and to do no harm.