Blog
Caring With Integrity
6 mins
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(Extended release)
Australia has a fantastic healthcare system, and - given this - it makes sense that more often than not we go into health services with the expectation that doctors and those trained to put our best interests first do just that (and do it well). At the best of times, this perspective is optimistic and at worst it’s nothing short of naive.
The truth is that the clinicians into whom we pour our trust are humans. Humans who make mistakes and make the wrong choices, who may not always act with the best intent, and who don’t always get it right. Most of the time this is not in bad faith (though not always, at least in my experience), but - regardless of intent - it can still cause harm.
Iatrogenic harm:
Harm experienced by patients resulting from medical care, whereas negligence is more narrowly conceived as deviation from standard care.
While all harm resulting from negligence is iatrogenic, not all iatrogenic injury is negligent. (AMA, 2025)
The reality is that multiple things are true at once.
The healthcare system in Australia is far better than that in many countries, and this is a privilege. we are lucky to have access to the standard of care that we do.
The majority of clinicians and practitioners may indeed have the best of intentions.
Even those with good intentions can cause harm to patients.
Some clinicians DO NOT have the best interests of their patients in mind. This might not always be out of malice, it may be from being over-exerted, a result of compassion fatigue, a lack of understanding, or a lack of time and resources.
Sometimes acting in a patient’s best interest means going against their wishes, and even when this is necessary it still can cause iatrogenic harm.
Doctors are sworn to the oath ‘do no harm’, but this in itself is something that cannot and never will be achieved. It is not something that any human can pledge, no matter what their intentions are. It is not something that any human can uphold 100% of the time. We all will cause harm to others and to differing degrees throughout the course of our lives, regardless of whether we mean to or not.
Iatrogenic harm gains power when it is ignored. When it is swept under the rug, covered up and minimised. When those who have been hurt are gaslit into believing they are the problem and that the mistakes that have inflicted suffering onto them are repeated for others.
This is exactly why calling out and talking about the negative aspects of treatment that inevitably occur in healthcare systems are so integral.it is also why it is so important that there is also a way to draw attention to the more serious violations of basic humility that (as much as we may be led to believe are very uncommon), still happen daily.
The problem is that acknowledging and owning mistakes is not common practice in a world so plagued by the need for deliverables, KPIs and glowing praise. A world that sees in such binaries and that so often fails to understand that acknowledging and utilising criticism is not what leads to downfall, but rather what strengthens and improves.
And so, the dilemma remains. If harm exists in silence, it is allowed to grow. In reality, if it is not actively brought to attention by those of us who fall victim to it, instances of iatrogenic harm remain invisible.
The solution? Well, besides burning the system to the ground and then back up again (which I’m sure many of us wish we could do), is to equip individuals to be their own advocate - to know their rights, to know when they have been breached, and to know how to go about bringing these occasions into the spotlight.
Whilst iatrogenic harm and what is referred to clinically as ‘notifiable events’ - which can and do occur across any and all facings of healthcare - there is a significant overrepresentation of these events amongst mental health patients.
As someone with lived and living experience of mental ill-health, I have received treatment voluntarily (by choice), ‘voluntarily’ (I say that in quotations to indicate that whilst technically a patient might be voluntary on paper, there are many instances that they are only compliant with treatment because of the threat that they will be made involuntary if they don’t), and involuntarily (I.e. as a patient under the Mental Health Act). I have seen the true colours of our mental health system and exactly how deep stigma, judgement, and prejudice seeps, even amongst those with qualifications in the area of mental health.
Whilst I have always been (or, at least tried to be) a health literate consumer*, there have been times that I have not known my rights, have not known how to stand up for them, and have not been able to identify the extent of the injustice that I was subject to. I was buried deep in shame and guilt, blaming myself and believing that I deserved the experiences I was having. I didn’t believe I had a voice and I certainly didn’t know I was entitled to have one.
It wasn’t until these instances of abuse escalated and I came across an advocate who informed me that I did - in fact - have rights that I learned that I was well within my rights to formally report and advocate for myself in relation to horrors and traumas I was living on a daily basis.
My experiences in a system that was not designed to support me have been incredibly formative. My adolescence was spent in wards and preparing for tribunals (the purpose of which was to argue that I had ‘capacity’ and should be allowed to make decisions about my own life). I also had to become my own teacher not just for my schooling (which I was perhaps too good at), but also relating to my rights.
I witnessed things that no human should ever have to. I saw fellow patients denied essentials and made to wear paper scrubs. I saw countless people pushed through a system with no support and discharged despite literally crying for more help. I saw people wait hours to access a toothbrush, denied the right to shower, stripped of their personal belongings, locked in a room with nothing but their mind (which is what led them to need help in the first place) and things too abhorrent to ever escape my mouth or mind.
It’s been several years now since I have been treated as an inpatient, which has most certainly not been easy. However, since seeing the dark and disturbing reality of psychiatric ‘treatment’, it has been my mission to contribute to its remedy.
In the last quarter of 2024, I decided to make plans that have existed majorly in my mind into something of a reality with Integrity Initiative.
Integrity Initiative is a project to make and deliver packs of care items and self-advocacy tools to people in Western Australia hospitalised for mental health treatment. Care items will include a combination of soaps, lotions, clothing, fidget toys, notebooks, toiletries, sanitary items, art supplies, and much more. These will be paired alongside a curated and individualised selection of resources designed to help them learn and develop self-advocacy skills.
Integrity Initiative - as a project - will be multifaceted.
Integrity Initiative will engage with the community in multiple ways to help combat mental health stigma, raise awareness, and open conversations about mental health and mental ill-health. It will aim to foster a sense of community and strengthen existing connections within the Lived Experience space.
Of course, a major part will be creating and delivering personalised care packages through several different mental health inpatient facilities across Western Australia.
Another major part of the project will be making, sourcing and distributing brochures, booklets, tools, and factsheets that intend to inform a person of their rights and equip them with the skills they need to stand up for these rights.
Integrity Initiative is beyond excited to be partnering with Care Opinion in this mission to attain equity, demand justice and amplify the consumer* voice. To inform people within the broken and fragmented institutions that compose the mental health sector as we know it.
As someone who has experienced iatrogenic harm myself, I have at times been dependent on the support of advocates who have taken the time to stand up for me. This, combined with my tenacity and my ability to educate and advocate for myself, has been my lifeline.
I cannot express how incredibly invaluable this work is. The importance of returning even an ounce of humanity, dignity and compassion through self-autonomy and the right to be heard can not be overstated.
Unfortunately, still we encounter the challenging truth that even though services like this exist, they are still not being used to their full potential as they continue to work tirelessly for greater awareness, with little to no support from institutions themselves.
I urge you to help us achieve our mission: to deliver dignity to those who are stripped of it. There is no form too insignificant.
Integrity Initiative needs your help.
Find out more on our website
*consumer in this context refers to a user of a health service
**the medical profession calls users of the service ‘patients’. Personally, I believe this term is indignifying and dehumanising (#peoplenotpatients).
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