A writer-in-residence piece written by Scott Fitzpatrick
A writer-in-residence piece written by Scott Fitzpatrick
Written by Scott Fitzpatrick – Centre for Mental Health Research, The Australian National University
For much of the previous decade the focus of suicide prevention has been on improving access to mental health services. Public health campaigns and education programs aimed at improving knowledge of the signs of distress, together with service delivery approaches that provide different intensities and modalities of care have been regular features of policy and practice. This approach, however, has often overlooked the fact that many people choose not to access health services for suicidal distress due to dissatisfaction with mainstream services, ineffective treatment, or previous contact with uncaring practitioners (Pitman & Osborn, 2011).
A key success of lived–experience involvement in the sector has been to draw attention to these concerns and to emphasise that services are not inherently beneficial in and of themselves, but have the potential to cause harm (Pilgrim & Rogers, 2005). As touched upon in my previous piece, under–resourced public hospitals and community mental health services, impersonal risk assessment procedures, no–suicide contracts, the pathologisation of suicidal thoughts, and the threat of involuntary detention can contribute to the creation of unsafe environments for those experiencing suicidal thoughts or distress.
The need for safe spaces for those in distress or crisis is in many ways self-evident. Many of these people have experienced trauma, may live or work in unsafe environments, or be involved in unsafe relationships or practices (Everett, 2009). The establishment of a National Safe Spaces Network seeks to address the above concerns, providing peer–led, non–clinical alternatives to care in a range of settings. Still in their infancy, not much is known about safe spaces. To address this research gap, the Co-Creating Safe Spaces project is currently underway with the aim of evaluating different safe space models across Australia.
Idealised and decontextualised notions of ‘community’ present in the term ‘community care’ has meant that little attention has been paid to specific sites of care (McGrath, 2012). The role of ‘place’ and ‘space’ in healing and recovery, however, is an integral part of how distress is responded to in society and has been well documented by geographers. Historical analyses illustrate the changing geographies of places and spaces of care for people with mental illness from the asylum, with its complex geographies of care, control and cure, through to contemporary psychiatric settings and the so–called post–asylum landscape that includes care in the community and nonmedical landscapes, such as natural and social environments (McGeachan & Philo, 2017).
Discussions of space and place are especially salient given the shift to community care and the importance of community participation and social inclusion in promoting recovery and wellbeing (Duff, 2012). The move from segregated institutional environments to normalised community settings, after all, has not resolved issues of stigmatisation, fear and exclusion for those experiencing distress, those deemed ‘at–risk’ of harm, or those labelled with a mental health diagnosis (McGrath & Reavey, 2015). Moreover, people who suffer mental health problems or experience distress often have very few safe spaces in the community and report frequent social isolation (Pinfold, 2000).
A key focus of research on place and mental health to date has been on the way people act, interact and move within spaces. This relational and dynamic understanding of space acknowledges the social, material and affective characteristics that shape experience (Duff, 2012). The social, according to Duff (2012), refers to the way spaces shape and mediate social interaction. The material aspects include those activities that specific spaces foster or make possible via their physical structure (eg, the built and natural environments), while the affective refers to the feelings generated by the physical and social experiences of space.
Laura McGrath’s (2012) work shows that people negotiate their distress across multiple spaces such as the home, community, the workplace and services, and that this can result in ‘concordant’ and ‘discordant’ experiences. McGrath’s work is insightful, taking us beyond conventional thinking about the medical or socio-political ‘causes’ of distress and its management to consider its dynamic nature and the influence of the spatial context in which it occurs.
Given the challenges of managing distress within and across a multiplicity of spaces, there are strong arguments for the creation of spaces that offers refuge, respite, and where expressions of distress are accepted and acceptable without an underlying agenda of treatment and recovery (Bryant et al., 2015; McGrath, 2012). This sentiment is captured perfectly by a lived–experience respondent in the recent National Safe Spaces Network Scoping Study: ‘People don’t just want treatment; they want a “safe space to fall, a safe space to fall apart”’ (KPMG, 2020 p. 123).
These developments, among other things, provide a timely argument for rethinking concepts of safety and associated practices that drive many of our suicide prevention efforts, yet that manifest differently within and across different spaces, and often, with very different outcomes for those experiencing distress.
Bryant, W., Tibbs, A., & Clark, J. (2015). Visualising a safe space: the perspective of people using mental health day services. Disability & Society, 26(5): 611-628.
Duff, C. (2012). Exploring the role of ‘enabling places’ in promoting recovery from mental illness: A qualitative test of a relational model. Health & Place, 18: 1388-1395.
Everett, B. (2009). Belonging: Social exclusion, social inclusion, personal safety and the experience of mental illness. Belleville, ON: Mood Disorders Society of Canada. Available at https://mdsc.ca/documents/Publications/BELONGING%20FINAL%20REPORT.pdf
KPMG. (2020). National safe spaces network scoping study. Canberra: Commonwealth Department of Health. Available at https://www.health.gov.au/sites/default/files/documents/2022/01/foi-request-3040-release-documents-national-safe-spaces-network-kpmg-national-safe-spaces-network-scoping-study.pdf
McGeachan, C., & Philo, C. (2017). Occupying space: Mental health geography and global directions. In R.G. White, S. Jain, D.M.R. Orr & U.M. Read (Eds.), The palgrave handbook of sociocultural perspectives on global mental health (p. 31-50). London: Palgrave Macmillan.
McGrath, L. (2012). Heterotopias of mental health care: The role of space in experiences of distress, madness and mental health service use. PhD thesis London South Bank University.
McGrath, L., & Reavey, P. (2015). Seeking fluid possibility and solid ground: Space and movement in mental health service users’ experiences of crisis. Social Science & Medicine, 128: 115-125.
Pilgrim, D., & Rogers, A. (2005). The troubled relationship between psychiatry and sociology. International Journal of Social Psychiatry, 51(3): 228-241.
Pinfold, V. (2000). ‘Building up safe havens… all around the world’: Users’ experiences of living in the community with mental health problems. Health & Place, 6: 201-212.
Pitman, A., & Osborn, D.P.J. (2011). Cross-cultural attitudes to help–seeking among individuals who are suicidal: New perspective for policy–makers. British Journal of Psychiatry, 199(1): 8-10.
About the Writer
Scott Fitzpatrick – Centre for Mental Health Research, The Australian National University
Scott is a Research Fellow in the Lived Experience Research Unit at the Centre for Mental Health Research, The Australian National University. Scott is an interdisciplinary scholar whose work is grounded in the sociology of health and illness, public health, and applied ethics. His research interests are suicide, the social and political determinants of health, and lived experience. Scott is especially interested in broadening contemporary ethical discussion of suicide and its prevention within the fields of research, clinical, and public health practice and policy by examining the intersection between knowledge, practice, ethics, and politics.