Criticism of the mental health system should not be equated with Scientology

For 30 years, Scientology has had a curious place in Australia’s legal and social fabric. Designated as a religion in the famous [to legal nerds] High Court case, Church of the New Faith v Commissioner of Pay Roll Tax (Vic), Scientology enjoys a raft of benefits including exemptions from taxation and anti-discrimination legislation.

Australia takes a different view to other nations, such as the United Kingdom, which takes a narrower definition of religion that excludes Scientology. There have, however, been pushes to amend Australia’s position [1], including most recently, a Sydney Morning Herald / Age article that quotes Professors Patrick McGorry and Ian Hickie.

While I am moved by the concerns that both Professors McGorry and Hickie state, I am concerned their recent article’s accompanying commentary about “activist consumers”, including those with “undisclosed links” to Scientology, erodes trust in important consumer voices.

The truth is that Scientologists and mental health consumer groups have little in common. Where they do overlap is in recognising the common harms that are caused by the mental health system.

This isn’t fringe. Deemed by Victoria's Royal Commission to have "catastrophically failed to live up to expectations", the mental health system has long been accused of violating human rights, taking an overly biomedical approach, and resisting opportunities to reform.

I can speak to these issues, having worked in human rights, research and regulatory roles across the mental health system. Unfortunately, I have witnessed a culture of practice within public psychiatry that, though having notable exceptions, has too easily overridden the wishes of consumers (aka patients) through involuntary treatment and breaches of the law by mental health professionals.

However, sustaining such a conversation is difficult. Regularly consumer groups who challenge or provide alternatives to mainstream services are discredited with unsophisticated labels like "anti-psychiatry”, or as some may interpret from this article, supporters of Scientology.

For example, in 2019 colleagues and I submitted a co-authored commentary response to an article published in Australasian Psychiatry titled “Hip Hip Hooray, ECT Turns 80!”. Our primary concern was the lack of consumer voices in an article purporting to give a history of electroconvulsive treatment in Australia. The response we received from the anonymous reviewer was revealing:

The main point of the letter is to critique Dr Clarke for failing to give space to the anti-psychiatry movement, and the anti-ECT lobby in particular. This anti-ECT bias is disguised in this letter as being about providing a consumer-led or lived experience viewpoint about ECT

The expression of such opinions is perfectly reasonable in a website blog, and would likely gain publication by the Church of Scientology, but do not really have a place in a scientific peer reviewed journal.

The editor would only include our commentary if our co-author’s critical first-person experience of ECT was removed. So, with few options, my colleagues published a response elsewhere.

The Scientology / anti-psychiatry characterisation is not limited to discussions of treatment types and their efficacy. It extends to criticisms of psychiatry for human rights abuses and the need for reform. In 2020 Professor Hickie characterised two UN reports (2) from the Special Rapporteur on Health as “anti-medical and anti-clinical rhetoric” and appeared to question the central importance that the UN had placed on addressing power imbalances between psychiatrists and consumers.

Such findings are also neither new nor controversial. For example, Victoria’s Royal Commission highlighted these at length, pointing to the negative impacts of “complex power imbalances rooted in professional, historical, social and statutory hierarchies” on mental health consumers who access or work in mental health services. Such findings were also throughout the Productivity Commission’s national report into the mental health system.

In the SMH / Age article, Professor McGorry is quoted stating that consumers harmed by the system are misguided in their concerns about a lack of accountability on clinicians:

However, some of these people ultimately failed to see that the (poor and underfunded) conditions themselves were the reason for the harm and neglect, and they blamed the clinicians and doctors who themselves have been victims of the neglect as well.

This account erases the expertise of thousands of consumers who gave evidence to public inquiries, and it contradicts the ultimate findings of these inquiries, which clearly spoke to power imbalances, culture, and a lack of regard for the law.

In systems trying to innovate their way out of out-dated cultures and practices, we cannot afford to collapse important debates into simple binaries. Our conversations on race, gender, and sexuality have all evolved beyond “reverse racism”, “man-hating” or the “gay-agenda”, and so should our debates about mental health. By linking Scientologists with critical mental health consumers in their commentary, Professors Hickie and McGorry risk using their privileged position to police more marginalised and critical voices from being part of the conversation.

Those critical voices do not reflect all experiences. I, for one, have benefited greatly from medical and psychosocial support in the mental health system. But like the Professors, I am an economically well-off white cis-male, and I must give voice to those less fortunate than me, including those that challenge me.

I invite both Professor McGorry and Hickie to clarify their comments in light of this so that we can have a unified rather than divisive debate.

[1] Barker, R. (2015). Scientology, the test case religion. Alternative Law Journal, 40(4), 275-279.