When the Front Door is the First Harm
A lived experience account by one of our Making Rights Real co-designers
| About This Piece This article was written by a member of the Making Rights Real (MRR) Co-Design Group — one of 16 people from across Australia with lived experience of psychosocial disability and mental health challenges who came together over 12 months to map the barriers between their lives and the good life they deserve. One of the project’s most consistent findings was that the way a person is received at the door of a service determines everything that follows. The MRR co-design group called the experience of being treated as an administrative task — rather than a human being — the ‘Processing Mindset.’ In response, they designed the Warm Entry Guide: a three-pillar framework built around Prepared Presence, the Relational Guide, and Calm Spaces. This piece is the evidence behind that framework. It is one person’s account of what happens when the intake process becomes the first harm — and a direct illustration of why ‘respect as a clinical metric’ is not an abstract principle but an urgent, measurable standard. |
Have you ever felt like dignity and respect are optional extras — things individuals and services may or may not choose to include in their interactions with you?
It shouldn’t feel like winning the lottery when you walk away from an interaction having been treated with respect, consideration, empathy, and feeling truly heard. This should be the baseline standard, not one that depends on luck or whether you’ve paid a premium to receive it.
| Reflection Think of a time you felt genuinely heard in a healthcare or support setting. What made the difference? What small thing did that person do — or not do — that changed the experience? |
I have faced mental health challenges for most of my life. I have experienced treatment in many settings — inpatient and outpatient, voluntary and involuntary, public and private, youth and adult. Unfortunately, an all-too-common thread throughout my journey has been a lack of empathy, compassion, or even simple respect. At times, even outright contempt.
On one occasion, when I was admitted as an involuntary patient, I immediately became over-stimulated and overwhelmed as I was moved onto the ward. The noise of other patients talking and shouting echoed through the corridors. Despite it being daytime — with plenty of natural light available — every single light was on. The bright lights reflected off the white walls. I remember my senses being completely overwhelmed, with no way to escape it.
For several hours I was left pacing in circles, fidgeting, and crying. The nurses could see my obvious distress from their station, but no one approached me to ask if I was okay or to check whether I needed help or support. I tried approaching the nursing station multiple times. Hours had passed and I still had not been assigned a room.
I asked staff if I could have a PRN medication to help lower my distress. I asked whether there was anything they could do to help assign me a room. It was so bad that I even asked whether I could wait in the high-dependency area until a room was ready — just to lower the stimulation.
Their answer was always no. Most often, without even an explanation as to why — and that absence of explanation only increased my distress. The few explanations I did receive made no sense: despite their claim to the contrary, I knew my medication chart had already been written up because I was present when it was. And despite staff saying there were no rooms available, I could see with my own eyes that multiple rooms were empty — they simply needed the beds to be made. I even offered to do it myself. I could not understand what the barrier was.
The standard response was that they were busy. Yet immediately after dismissing me, I could see staff returning to the nurses’ station, sitting down, and chatting and laughing with each other.
Were they laughing at me? I didn’t know. It was either that, or they were laughing at other patients, or simply having social conversations amongst themselves. Whatever it was, they were clearly having a great time.
It would have taken just a couple of minutes to help me. Why wouldn’t anyone help? Why was everyone ignoring me as though I didn’t matter at all?
My distress and frustration kept building. By that stage, I just needed to escape.
| Reflection The Warm Entry Protocol describes staff who sit ‘behind high desks, clinical jargon, and standard operating procedures to maintain professional distance.’ What does visible, unaddressed distress communicate to other consumers in a waiting area? What would have taken two minutes to do differently in this story? |
Somehow, in that moment, I was able to take action. I told my nurse that I did not believe I met the criteria to be held as an involuntary patient, that I wanted to be discharged, and that the hospital environment — as they could all see — was causing me increased distress.
While being ignored by staff, I had managed to arrange for additional supports in the community. I planned to use this to advocate for discharge. I told my nurse I wanted a second opinion from a different doctor and reminded her that this was my right — that I was legally entitled to it.
The fact that I knew my rights and had started advocating for myself angered my nurse. In her mind, I had now become a ‘difficult’ patient. She made it crystal clear that she had no intention of spending any of her energy helping me.
At the end of her shift, that nurse found what seemed like extra pleasure in publicly mocking and tormenting me. As staff were leaving, she noticed I was watching. She mocked me in front of her colleagues — gyrating, skipping, and waving; smiling in an exaggerated fashion and calling out that ‘unlike you, I get to go home now.’
Her colleagues laughed along with her.
To this day, that image is locked in my mind.
No one should be treated this way.
| Reflection The MRR project identified ‘Systemic Aggression’ as one of its key friction triggers — the use of labels, mockery, or restricted access to punish consumers who advocate for their rights. Where do you see that dynamic in this account? What does it tell us about what the system is actually protecting when a consumer is labelled ‘difficult’? |
The Pain Point and System Structure: Dehumanising Care
When economic efficiency triumphs, systems get stretched. When staff are pushed beyond their limits, a culture where empathy, respect, and dignity are not fundamental requirements can take hold. Instead, they become optional extras.
The Mental Model
A model develops — and is perpetually reinforced — where a lack of empathy is normalised and accepted as inevitable.
This can mean that even the basic purpose, principles, and general obligations under the UNCRPD (Articles 1, 3, and 4) are not met. Fundamental freedoms, human rights, inherent dignity, and humanity itself are disregarded. In accessing the very systems and services established to assist us, people may face cruel, inhuman, or degrading treatment (Article 15).
Even though I was very unwell and in genuine need of the additional support a hospital should provide, I was placed in a situation where it was not safe or accessible for me to receive the care I needed.
No matter the service, the caseload, which staff member you are assigned, or how ‘challenging’ your needs are perceived to be — you should always be treated with dignity and respect and be free from inhumane or degrading treatment. This needs to be a baseline that is both mandated and actively monitored. It needs to be built into services from the ground up, and opposing behaviour must be actively discouraged, with services held accountable for their actions — and the actions of their staff — in meaningful ways.
Article 4 of the CRPD requires States to protect the rights of people with disabilities through a range of mechanisms: legislation and administrative measures, including regulations, policies, customs, and practices; ensuring that public authorities and institutions refrain from acting in ways inconsistent with the Convention; and taking appropriate measures to eliminate discrimination by any persons, organisations, or private enterprises.
| Reflection The MRR co-designers found that ‘respect as a clinical metric’ — measured through mystery shopping by paid consumer auditors, real-time exit surveys, and publicly available accountability data — could make dignity observable and measurable. If respect had been a mandated and audited standard in the ward described here, what might have been different? What would need to change in how services are funded and assessed to make that real? |