The Structure of Crisis

My essay this week is late because life got in the way. Yesterday I attended a gathering for my friend’s 40th birthday. It was a room full of people who loved her, people who showed up because they cared. She would have loved it, I’m sure, but she wasn’t there. She took her own life in 2022 after a long battle with her mental health. I remember the period she passed away with clarity. Not just because of her death, but because of where I was at the time with my own mental health. In May 2022, I made a post on Instagram titled The Long Road to Healing. It was the first time I publicly disclosed that I am a CSA survivor. It felt like a breakthrough moment for me. The 18 months leading up to that point had pushed me close to the very edge. I knew what it was to feel like there was no way forward, to no longer feel the light.

So, when I shared that post, I felt something close to pride. A sense that I had come through something and could finally stand on my own feet again. A week later, my friend died, and almost immediately, that feeling collapsed into guilt. Guilt for speaking. Guilt for feeling proud. Guilt for being so self-indulgent. Guilt for not helping. It’s a contradiction that has stayed with me in many ways. I did not attend her funeral because, emotionally, I could not handle it.

Ever since then, I’ve been looking more closely at the way we talk about mental health, and more importantly, the way we don’t. There is a dominant story we tell about suicide. It is a story about individuals who become unwell, who struggle, who reach a point where they want to die. Individuals who must be helped, intervened upon, stabilised, and kept alive. Everything in that story happens at the level of the person, and there is truth in that, but it is not the whole truth. If you step back even slightly, patterns begin to emerge. Depression, suicidality, and chronic distress are not randomly distributed experiences. They intensify under certain conditions and ease under others. Social isolation, economic instability, insecure housing, lack of access to care and a persistent absence of prospects are structural conditions, and they shape the psychological lives of the people living within them. Yet the dominant model of mental health, the one that informs most services, most interventions, most public messaging, remains fundamentally individualist.

It treats distress as something that originates inside the person and must be managed there. The result is an overwhelmingly reactive system. We wait until someone reaches a crisis point, we intervene, and we try to keep them alive. This is what is often described as a “downstream” approach because it focuses on the moment of acute risk, rather than the conditions that produced it. An “upstream” approach would look very different. It would ask why so many people are reaching that point in the first place. It would look at housing, labour conditions, social fragmentation, and access to care, not as secondary concerns, but as central to mental health outcomes.

But upstream solutions are difficult. They are costly, and they require structural change. From the late 20th century onwards, particularly with the rise of what is often called neoliberal capitalism, there was a marked shift in how societies organised themselves. Public services were reduced or restructured. Markets were expanded into areas previously governed by public provision. Labour became more flexible, more precarious. Unions weakened as work began to extend into the home through technology. At the same time, responsibility increasingly shifted onto the individual. You are responsible for your employment, your housing, your wellbeing, and your resilience. If something goes wrong, the starting assumption is that the problem lies with you.

Within that framework, it becomes difficult to meaningfully address mental health at a structural level. Not because the link between social conditions and psychological distress is invisible, it isn’t, but because addressing it would require challenging the very system producing those conditions. So, a different solution emerges. One that allows the system to continue largely unchanged. It is in these systems where the role of “services” becomes more complicated. In theory, they exist to help, and many people within them genuinely want to do that. But structurally, they are constrained. A useful concept here is what some scholars refer to as the non-profit industrial complex: a network of organisations, often reliant on state funding or institutional support, that operate within tightly defined parameters. They are tasked with managing social problems, but not with fundamentally altering the conditions that produce them. In practice, this creates a ceiling. What is particularly problematic about the increasing role of non-profits in providing social services is that many of these organisations are characterised by a formal, hierarchical, and typically elitist structure. More importantly, these hierarchical organisational structures are encouraged by the state, which has a great deal of influence on the inner workings and agendas of these organisations. (Rodriguez, 2007)

For many people, the most immediate form of help available is a crisis line, a voice at the end of a phone encouraging them to hold on for another day. Even when people access more intensive services, the experience can be cyclical. Crisis. Intervention. Temporary stabilisation. Return to the same conditions. And then, often, back into crisis again. This is not simply a failure of delivery; it reflects what the system is designed to do because, at a structural level, there is no strong incentive to eliminate the root causes of distress. A system organised around productivity does not necessarily require people to be well. It requires them to function. A person who is struggling but still able to work remains economically viable. From that perspective, interventions that keep people alive and minimally functional are sufficient. Interventions that would require large-scale redistribution, or a reorganisation of social and economic life, are far more costly, politically and economically. So, the emphasis remains where it is most manageable: at the level of the individual.

This is not abstract for me. Over the past year, through my work with Victorious Voices, I have been documenting institutional responses to harm, specifically, the experiences of CSA survivors navigating systems that are supposed to provide support and accountability. What I have encountered is not a small number of isolated issues, but rather it is a pattern of systemic failure. This past week, I compiled a 237-page file detailing interactions with Greater Manchester Police and the Greater Manchester Combined Authority. The failures documented are not minor oversights or procedural errors. They are, in many cases, fundamental breakdowns, instances where basic responsibilities were not met.

And yet, despite this, the dominant response has been consistent: Acknowledgement without accountability. Recognition without consequence. A kind of institutional language that concedes just enough to appear responsive, while ensuring that nothing of substance changes. This is where the connection to mental health becomes unavoidable. Because when systems fail in this way, when people are not protected, not heard, not supported, it does not remain at the level of policy. It becomes psychological in that it shapes how people see themselves, how safe they feel in the world and whether they believe there is any point in asking for help at all.

And when those failures are repeated, denied, or minimised, the impact compounds. We often talk about mental health as if it exists in isolation. As if it can be addressed through awareness campaigns, individual coping strategies, or short-term interventions alone. But mental health is not separate from the conditions people live in. It is produced, shaped, and sustained by them. If those conditions remain unchanged, if insecurity, isolation, and institutional failure persist, then the outcomes will persist too.

The question, then, is not simply how we respond to crisis. It is whether we are willing to confront the structures that make crisis so common in the first place. Because if we are not, then what we call a mental health system is not really a system of care. It is a system of management, and it will continue to do exactly what it is designed to do while we continue to attend the birthday parties of loved ones who decided they didn’t want to stick around.