Le grand silence des professionels/ The great silence of the professionals

I just acted in a play called maladjusted which toured in 26 cities in British Columbia and Alberta. We played in small and large venues, community halls, school gyms and theaters. The audiences numbered from 50 to over 300, and everywhere the message was the same. Our mental health care system has big problems and most professionals are silent about it.

maladjusted is a participatory play produced by Theatre for Living in Vancouver, Canada and directed by David Diamond. The play explores the mechanization of mental health services and the possibility of “human-centered care.” Patients and
caregivers developed and acted in the play. Using the interactive strategies of Forum Theatre, audience members had opportunities to role-play and suggest policy, resulting in policy report that has been sent to government agencies.

Some of the main recommendations were:

Prioritize relationship building over efficient diagnosis and treatment.

Prioritize counselling and psychotherapy.

Prioritize relationship building over efficient diagnosis and treatment.

Empower patients to make choices about treatment.

Offer greater support for patients coming off of medications.

Increase access to mental health care.

Increase access to care without requiring psychiatric diagnosis.

Increase advocacy, peer and cultural support for patients.

Prioritize workplace team building and self care for mental health professionals.

Increase public housing support.

Recent economic constraints, administrative restructuring into corporate-like health care systems and the singular reliance on the categorical system of the Diagnostic and Statistical Manual of Mental to organize services has resulted in criticism that the mental health care system in Canada has become mechanized

In 2013 Michel Gervais, writing to the Mental Health Commission of Canada, described how the metaphor of mechanization has become dominant in health care organizations. He draws our attention to the proliferation of bureaucratic
forms of organization that emphasize precision, speed, reliability and efficiency through increasingly fixed divisions of tasks, hierarchical supervision and detailed regulations. From the consumers’ viewpoint, this can be experienced as being treated more like a number, a diagnosis, someone that needs to fit a treatment model rather than an individual. This approach can also lead to more rigidly applied criteria for access to scarce and time limited resources with few or no
alternatives available. According to Gervais, this bureaucratic machine is doomed to fail, as it is not a viable fit for the shifting and complex nature of mental health issues.

At each performance it was noted that many professionals were aware of this failing system and were experiencing burn out. The professionals’ burn out and dissatisfaction has been documented for years. Yet health care associations remain largely silent. So why are they not reacting?

I believe there may be several reasons. In Canada the professionals (in particular doctors) are well paid. Many are silenced by the administrative structures they work in and fear loosing their jobs if they speak out.

Other professionals are like missionaries. They do not question the system and believe in it. Many do not even believe there are other options for the system.

Finally, many are not even aware that they are being influenced and bought by the powers within the system. This is particularly evident when it comes to the marketing strategies of the pharmaceutical industry.

We all have our own stories and some of us work in better conditions than others but I believe that most professionals know about the limitations of the system. We owe it to ourselves, to our profession and above all our clients to resist. Resistance is not futile. Either as individuals or as associations we need to be heard and be seen doing the right thing. If we do not, we will loose what credibility remains and our society will suffer the consequences.

The making of the play and its content is described in a published article:

Maladjusted: Participatory theater about human centered care, Arts and Health:

An International Journal of Research, Policy and Practice 2015, 7:1,75-85,

The full reports on the play are available on the web site of Theater for Living website.


The video of play is also available on YouTube:


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