We Don’t Want More Beds, We Want Disability Justice

It is a truth universally acknowledged that a crazy person in possession of an episode must be in want of a bed.

This is An Unquiet Mind, a National Magazine Award-winning column by s.e. smith that explores disability identity and its interaction with the world at large.

The sane say we need more beds. The general public has heard that the United States is experiencing a “mental health crisis.” Roughly 20 percent of the population experiences symptoms of mental illness in any given year, and many “lack access to care.” I use quotes not to be dismissive, but because there are many ways to define care, and not all of them are encompassed in mental health awareness rhetoric. This term often means medication, hospitalization, psychiatrization—things to make people less crazy—and may or may not include affirming community, alternative modalities, and other things that help people decide how they want to live with their crazy.

There is a very specific type of care sane people want us to have, one that shrinks us down to size and does not include all elements of existence with a mental health condition. It does not include mad pride—the embrace of mental illness as an identity—or the rejection of treatment, let alone the need for true care, for community, for gentleness. When many in our society talk about the “mental health crisis,” they mean people in crisis—crazy people who need urgent, emergent care. Those people might not have landed there in the first place in a more empathetic, truly caring society that doesn’t leave people alone to unravel.

Their solution to our “mental health crisis” is, I have been reliably informed, beds. Beds in psychiatric facilities, specifically. We need more beds, we need to build more buildings to house them, we need to train more people to “manage” the people who occupy them, we need to pass more laws to compel people to use them. Across this great nation of ours, crazy people can be forced to take medication or institutionalized against their will, and, amazingly, sane people congratulate themselves for this—for getting those crazy people the care they need.

In March of 2020, Daniel Prude was killed by police after his brother called for help during a mental health crisis—the police were, as is commonly the case, not indicted. In 2016, Ugandan refugee Alfred Olango was shot by police after his sister called for help—no criminal charges. In 2014, police killed Jason Harrison at his own home after his mother called for help with getting him to a hospital—no indictment. Families call for help (not necessarily a bad thing) because they feel they are out of options; because a loved one is struggling, overwhelmed, and drowning, and they just want someone to step in and make it better, often with a bed. All they know is 911 or a mental health hotline, and that is what they dial, and it ends in death.

Beds transmute into a form of policing while simultaneously being promoted as an alternative to policing. Rather than using police as mental health first responders, some say, we should have crisis intervention teams and mental health crisis teams and mental health first responders who will, inevitably, usher people into beds. The promotion of beds and people to guide crazy people to them (where they will be “safe”! And not allowed to leave!) then becomes a swapping of authority figures, white coats for blue uniforms. It is a reflection of ancient tradition: For thousands of years, we have been locking crazy people away so society does not have to deal with them. In the nineteenth and twentieth centuries, the bed promoters took on a heavy PR shift to make it clear that they were “helping”—that treatment and return to society was the goal (unless you have committed a crime, and then you shall stay immured behind institutional walls for good, friendo).

The promotion of beds and people to guide crazy people to them then becomes a swapping of authority figures, white coats for blue uniforms.

Mad people have been protesting psychiatric abuse and institutionalization for centuries and have been organizing movements around alternatives to hospitalization for a very long time. Some of those movements have focused on community care—not just outpatient treatment, but also the cultivation of a society where the mad are welcomed as part of the fabric of life and where they are accommodated as whole beings and receive supports that prevent crises. The mad pride movement, which gained new ground in the 1990s when mad people took to the streets for pride parades celebrating their community, has advocated very specifically not simply for a community in which care means conformity with sane expectations, but for a world where mad people are allowed to be themselves. One way they do so? With bed pushes, in which hospital beds with a stunt patient are pushed through the streets, taking the bed discourse out into the light of day. In both cases, goals include changing the discourse around beds as the only solution for psychiatric distress, redirecting the discussion about the mental health crisis away from institutions and toward communities, and questioning whether beds are truly needed at all.

The specific turn toward beds as a replacement for policing is troubling, especially as it has become more popular with larger conversations about police reform—or, preferably, abolishing the police. Mental health response is one area where society seems to generally agree that police involvement is bad and shouldn’t happen, but where white people really seem to struggle when it comes to alternatives. More beds, they suppose; maybe mental health parity laws and other things designed to get people medicalized care—a crazy person should always be able to access medication and psychiatric care (even non-psychiatric therapy, if we’re feeling generous). A failure of imagination sets in beyond that.

The tragedy of this is that Black mad activists have been fighting the good fight against institutionalization for decades. This is personal for them: Systemic racism interacts with mental health in ugly, dangerous ways. Most mental health care workers are white, and their Black patients are more likely to be diagnosed with severe mental illness—this itself a legacy of the psychiatrization of Blackness and the pathologization of responses to trauma—but less likely to receive access to a full spectrum of treatment options. Black advocates have a number of excellent recommendations for addressing the crisis of mental health care in this country. The 8 to Abolition organizers, for example, stress “care, not cops” as a pillar of their work. BIPOC advocacy work more broadly includes integrating larger ideas about disability liberation and justice into the conversation of how we support mad people. Support: not deal with or even include them, but actively reckon with societal disablism and structures in a world in which madness is woven into the fabric of society. Yet the voices of these activists are often ignored by white people who have been swift to leap on the “defund” bandwagon without fully understanding what it means. (“Hey, maybe we could use some of that defund money on more beds!”)

How do we, the mad, convince you that we do not want beds?

Can we do it with statistics, showing you hard evidence of outcomes in outpatient settings? Can we do it with testimonials and the voices of mad people who have received community care and support and thrived? Can we do it with the calm, rational words of policy experts who can present things in nice, nonthreatening briefs? Can we do it in court, with lawsuits to free ourselves? Can we do it with a documentary that takes you through the halls of closed treatment settings? Can we resurrect Nellie Bly for another ten days in the madhouse? Can we do it with TikToks? A conference? A clever stunt with a box and some inflatable jellyfish? Only tell us, and we will do it. And perhaps then you will find yourself thinking, “Hmm, maybe beds are not it,” and you, too, can join in the undoing of centuries-old infrastructure that was designed to keep the mad under control.

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