Abolitionist perspectives on epistemic injustice in psychiatry

This post by Cath Roper and Nina Joffee-John explores abolitionist perspectives on how to address epistemic injustices in mental healthcare, drawing on interviews with mental health service users/survivors.

Unlike physical health, which protects the principle of informed consent to treatment, specific legislation enables public mental health services to authorise detention, administer treatment to persons without consent, and use restrictive practices. In most jurisdictions, such legislation operates across inpatient and community settings, invoking human rights issues.

People who have been labelled as ‘mentally ill’ belong to a group whose testimony can be doubted on grounds that it is faulty, unreliable, untrustworthy. We are often seen to lack ‘competence’ and ‘insight’ and our knowledge is not given credence. We can even be placed under the aegis of mental health legislation on these grounds.

Most of the researchers in our study had a lived experience of public mental health services.  Because of this, our perspectives could be regarded as inherently untrustworthy and we could experience  ‘testimonial injustice’.  The epistemic power of law and medicine, with their positivist, scientific worldviews, have the potential to combine and disqualify other worldviews, in particular the worldviews of people labelled ‘mentally ill’.

As researchers, we ourselves could be subject to testimonial injustice.  Our research could be dismissed on grounds of being ‘biased’ because we sought our key informants for their critique of mental health laws, a voice seldom heard in the formal literature. We aimed to gather the opinions of advocates and survivor activists on this topic in order to amplify these perspectives, contributing to epistemic justice.

Ongoing debate about coercion authorised under mental health laws is generally discussed by legal and clinical academics and typically centres on when it can be justified and how it can be reduced. Using a snowball sampling technique, we conducted interviews with 15 key informants across 5 different countries, who were known to hold a critique of mental health laws.

Informants thought these laws were discriminatory, caused harm and could not be justified. Mental health laws were criticized for breaching human rights, denying legal capacity, and displacing consent while forced psychiatric interventions were equated with torture and violations of freedom of opinion and expression. Psychiatric abolition was linked to broader movements like prison abolition and anti-colonial activism. Activism was positioned as essential to dismantle coercive systems and create new possibilities for non-violent, community-led care.

Abolition was proposed as a necessary response to the injustices of mental health laws,  involving daily steps toward creating a more just and equitable society.  Our findings showed imperatives to dismantle mental health laws on human rights grounds and to de-carcerate care. An urgent need to consider First Nations or Indigenous peoples’ activism and self-determination as abolition leadership was prominent in our findings. Informants suggested investing in social determinants, community-based care, and peer-led support systems as alternatives to coercive mental health practices.

Examples from countries without mental health laws, such as Thailand and Nepal were highlighted.  Peru was presented as a country that has come closest to putting a supported decision-making regime in place that operates on an equal basis for all citizens. Community-based models like Trieste, Italy, were highlighted, which were founded on social inclusion and human rights. Human rights frameworks, such as the UN Convention on the Rights of Persons with Disabilities (CRPD), were seen as powerful tools for advocacy and reform.

Abolition theory and practice provide ‘hermeneutic resources’ so people can understand their social experience, informing social justice and community-led responses to care. Taken together, our findings provide a step-by-step model for abolition in psychiatry.

To read the full open access article and share through your networks: https://www.sciencedirect.com/science/article/pii/S0160252725000937 

Author bios

Cath and Nina are lived experience academics working at the University of Melbourne, Australia. Each has lived experience of involuntary mental health treatment and detention, including seclusion and restraint, which profoundly shaped their understandings of and commitment to social justice, equity, and freedom. They use these perspectives to consistently critique the ethics and operations of mental health laws. Nina is pursuing a career in law.

The Case for Epistemic Justice in Mental Health Nurse Education

When I first encountered the concept of epistemic injustice, I experienced a powerful moment of epiphany.  As a mental health nurse, lecturer and patient, I recognised it instantly. Not just as a philosophical concept, but as something I had witnessed and sensed in clinical practice as both a nurse and a patient.  

Mental health patients are frequently disbelieved, discredited and silenced, often when they are in most need of being heard.  This began my passion to embed the concept of epistemic justice into mental health nurse education.

Nurses talking to each other

Listening Is Not Enough

Listening is a central tenet of mental health nurse education, enshrined in regulatory guidelines and nursing rhetoric.  However, patients and psychiatric survivors have long since complained of dismissal and silencing at the hands of healthcare professionals inflicting long lasting iatrogenic harm. 

Instructing mental health nurses and other professionals to ‘listen more’ is a woefully inadequate response to entrenched epistemic injustice that exists within healthcare structures. This oversimplification ignores the complexities of social and medical power entwined with knowledge creation and exchange.  

Diagnoses that Drown Out Meaning

Discourses on epistemic injustice within mental health services often overlook the role of psychiatric diagnosis itself in perpetuating injustices around meaning making and testimony.   

I have taught students to assess people’s needs, plan care and manage risk. But I’ve also witnessed personally and professionally how quickly clinical language can strip meaning from a person’s story. And when we don’t teach students to notice this, challenge it, and reflect on their own assumptions, we risk reinforcing the very systems that silence the people we aim to support. We must deploy humility and acknowledge that mainstream psychiatric hegemony does not have the answers and has a questionable evidence base at the best of times.

Health education

Why It Matters in Nurse Education

As a mental health nurse lecturer, I believe that if we want to change clinical culture, we must start in the classroom. It is here that future nurses learn how to interpret, categorise, and respond to distress. It is here that they learn what counts as knowledge, and who counts as a credible knower. Are we preparing students to truly hear the voices of those they care for? Or are we, unintentionally, teaching them to privilege professional knowledge at the expense of lived experience?  

We need to create space in healthcare education to explore discomfort, ambiguity, and the limits of our own understanding. We must invite patients and survivors into the centre of our learning not as case studies, but as co-creators of knowledge.

What Would an Epistemically Just Education Look Like?

To me, bringing epistemic justice into mental health nurse education means:

• Teaching students to be critically reflective about whose voices are heard and whose are dismissed.
• Valuing lived experience as legitimate knowledge, not just as supplementary to clinical expertise.
• Interrogating the power of diagnostic culture, rather than accepting it as neutral or absolute.
• Creating space for discomfort and complexity, where not everything has to be neatly categorised.

It is not about teaching students to reject biomedical knowledge, but about holding it alongside other truths, especially the truths of those who have too often been silenced by the very systems designed to help them.

Why It Matters

I wrote this paper because I believe we have a responsibility, not just to care, but to care justly.  Bringing epistemic justice into healthcare means more than simply listening better. It means rethinking how we define expertise, how we structure conversations, and how we respond to stories that don’t fit neat diagnostic boxes.  It means recognising that silence is not always chosen, and that some voices have been trained into quietness by years of not being heard.

My hope is that by naming these injustices, we can begin to confront them. That we can move towards a model of care where knowledge is shared, where voices are valued, and where being heard is not a privilege, but a right.

The classroom is the place to begin.

Jane Fisher is a mental health nurse lecturer at the University of Central Lancashire.  She is simultaneously someone who has used mental health services, and lives with an imposed label of ‘mental illness.’  This gives Jane a unique vantage point.  

She has worked in frontline mental health services, accessed mental health services, and educates pre-registration mental health nursing students.  Jane is an internationally published author, offering a critical perspective on psychiatry and mental health, often using her lived experience to challenge the status quo.  

Published papers include topics such as epistemic injustice, identity, nurse education, and the problem with resilience.  Jane’s personal mental health struggles have fuelled her passion to challenge stigma and power asymmetries within mental health care, whilst shining a light on inequalities, iatrogenic harm and the true value of mental health nurses.