"What about that violence?" Transforming the discourse on violence in mental health research and services

Research on violence in mental health has long been dominated by behavioral science, risk assessment, and legal definitions of harm that conceptualize violence primarily as observable acts committed by individuals with mental illness. This orientation has produced a field capable of measuring and predicting such behavior, while largely failing to name the forms of violence experienced by people affected by mental illness, including institutional, structural, and epistemic harms. Grounded in reflexive engagement with RAP-Proches - a participatory action research project examining violence in the context of mental illness and family caregiving in Québec, Canada -, and drawing on peer-reviewed literature across psychiatry, psychology, public health, and social sciences, we seek to transform mental health research and services by proposing a reconceptualization of violence in mental health using Johan Galtung's framework of personal, structural, and cultural violence. Galtung's triangle reveals how these three forms are interconnected and mutually reinforcing: cultural violence legitimizes structural violence, which in turn shapes the conditions under which personal violence occurs. Put in dialogue with Miranda Fricker's theory of epistemic injustice, this framework shows how the concentration of research on personal violence reproduces the conditions under which institutional and structural harm remains unnameable, leaving those harmed by institutions without the conceptual tools to name that harm as violence. We identify conditions for epistemic justice in research (including reciprocity, acknowledgment of trauma, and recognition) as concrete mechanisms for disrupting these dynamics.