An Interesting Framework That Deserves to Be Developed and Used Widely

An Interesting Framework That Deserves to Be Developed and Used Widely The author reports no conflict of interests. Friesen's "Why Democratize Psychiatric Research?" is an important piece of work and makes a compelling epistemic and ethical case. As someone who has spent decades in the field of (in chronological order): survivor involvement, service user involvement, patient and public involvement and now lived experience; I am delighted when I see a robust reminder of the reasons why we need to take this seriously. The author is right to stop us sleepwalking into an activity because funders expect it, psychiatry now prides itself on it, and academics write countless pieces on it. People who have not lived in a time when our involvement in research was entirely counter-cultural (or even symptomatic of a patient lacking insight) could be forgiven for thinking it was always like this. There are, however, three themes that could and should be developed from this thinking. They concern assumptions about general medicine, the institutional discrimination within psychiatry, and the significant cultural change that has occurred since the rise of the survivor movement as one of the later rights movements of the last century. Many years ago, I would have made the same argument about how psychiatry lacks the objectivity and testable biomarkers of general medicine. As I have spent more time with assorted medics, many at the top of their game, it is clear that there is much more subjectivity across much of medicine and rather than place psychiatry as uniquely needing more democratic research (a proposition I wholeheartedly endorse), I would love to see us take these arguments into medicine as a whole. Until we do this, we risk "othering" psychiatry as a whole rather than showing an area in which psychiatric patients (or survivors, or service users, or people with lived experience, as you wish) can become leaders in progressive medical thinking. A more important omission which needs significant addressing if we genuinely are to democratize psychiatric research is the racial inequality within psychiatric practice. There are many inequalities both within psychiatry and in broader society that contributes to mental health inequalities, but the experience of racialized communities, in our End Page 139 psychiatric services has been a consistent theme. For those unfamiliar with the extent of difference between White and Black experience of UK psychiatry you need only look at the differential rates of detention under mental health legislation. National Health Service data show that people from minority ethnic groups are more likely to experience compulsory detention than their White counterparts. In 2020/21, rates of detention by ethnicity were Black or Black British: 309.4 per 100,000 people compared with White: 76.2 per 100,000 people (National Health Service Digital, 2021.) If we are to truly democratize research in psychiatry, we need to more actively engage racialized communities and ensure that they are leading and coproducing more of our research. Although this forms part of the argument in feature #3, it warrants being front and center of features #1 and #4 where the differences between Black and White are so marked. We as democratizing researchers should be carrying an anti-racist banner high and doing more to both improve our own practice and constantly challenge a psychiatry that has failed, review after review, to address this. The Whiteness and Race Equality Network, part of the Collaborating Centre for Values Based Practice1 is working hard on this theme but much more is needed. The final challenge which needs addressing, and one which certainly needs the analytical skill and clarity of thinking that Friesen has applied throughout, is the breadth and diversity of what now constitutes "lived experience" in mental health. Even if we restrict our scope to psychiatry, this is a much broader research field than when survivor research started to be taken seriously. The vast majority of survivor researchers would have spent considerable periods of time as inpatients in psychiatric hospitals, often as detained patients. None of us would have chosen to self-diagnose, most of us would have done all we could to shed our diagnostic labels, some of us find it hard to forget...