LOS ANGELES - Marylandian -- The World Health Organization (WHO) has issued a powerful new directive urging nations to eliminate coercive psychiatric practices, including forced hospitalization, drugging, and seclusion. The Guidance on Mental Health Policy and Strategic Action Plans outlines a rights-based approach that marks a sharp departure from institutionalization and involuntary treatment. The Citizens Commission on Human Rights International (CCHR), a global mental health watchdog, has welcomed the guidance while warning that U.S. psychiatry remains dangerously out of step.

The new WHO framework expands upon existing United Nations human rights resolutions that have consistently declared coercive psychiatric practices torture and an abuse of patient autonomy and human rights. According to the Guidance, mental health care must be voluntary, informed, and person-centered.

WHO Principles: Ending Abuse, Enforcing Accountability

The WHO recommends:

• Prohibiting involuntary psychiatric treatment
• Abolishing forced hospitalization and medication
• Upholding the right to refuse treatment
• Respecting advance directives that allow patients to refuse care in crisis situations
• Preserving individuals' legal capacity to make their own decision

The WHO further demands robust accountability measures, including public tracking of:

• Voluntary and involuntary psychiatric admissions
• Use of physical, mechanical, and chemical restraints
• Patient deaths in psychiatric institutions
• Use of psychotropic drugs
• Violations of advance directives

Despite these mandates, CCHR points out that the U.S. lacks a national, publicly accountable system to collect or publish such data. Transparency is scarce, and institutions are rarely held accountable for harmful or fatal outcomes.

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A rare investigation by a national news outlet revealed that, between 2020 and 2023, exposed a deadly national pattern—a lack of transparency and accountability involved in patient restraint and seclusion in hospitals generally, including behavioral and psychiatric. From 2020 to 2023, it found more than 14,300 patient deaths linked to restraint or seclusion. Nearly 1,000 involved drugs used as chemical restraints, including opioids, sedatives, and antipsychotics. Nearly 2,700 patients died while in seclusion or restraints, and almost 11,700 deaths occurred within 24 hours of removal from restraint or seclusion.[1]

These deaths, however, reflect only one aspect of systemic coercion. Research shows that more than half of psychiatric admissions in the U.S. are involuntary.[2] On a single day in 2018, 57% of psychiatric hospital patients were admitted against their will, rising to 89% in public psychiatric facilities.[3]

Patients in these environments report widespread abuse:

• 31% report physical assault
• 8% report sexual assault
• Most witness traumatic incidents during their stay

"The data is clear—coercion is not a rare exception under U.S. psychiatric treatment. It is a defining feature of the system," said Jan Eastgate, President of CCHR. "And the longer this is ignored, the more lives will be lost to silence, trauma, and preventable harm and deaths."

The WHO Calls for Systemic Change

The WHO's solution is bold: close institutions and eliminate financial incentives that perpetuate institutionalization. CCHR strongly supports this recommendation, having documented ongoing abuse in high-volume psychiatric facilities, especially those operating under profit-driven models.

Numerous reports have exposed neglect, physical assaults, and preventable patient deaths in such environments, including in 21 for-profit psychiatric hospitals in California.
"These facilities often operate without effective independent oversight or transparency," said Eastgate. "It is unacceptable that vulnerable individuals are placed in high-risk environments with little to no accountability for the patient sexual abuse, forced treatment and deadly restraints that occur behind closed doors."

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Rejecting the "Brain Disease" Model

The WHO Guidance also challenges the prevailing psychiatric model that treats mental distress as a brain-based disease requiring lifelong drug treatment. Instead, it promotes non-coercive, person-led recovery and psychosocial supports.

It calls on governments and providers to:

• End forced drugging and community treatment orders
• Ensure patients can legally refuse psychiatric drugs and other treatment
• Support individuals in safely withdrawing from psychiatric drugs, with full disclosure of risks
• Make non-drug interventions the first-line approach
• Redirect research funding toward rights-based, service-user-led models of care

CCHR emphasizes that these principles are not radical—they are now the official global standard. Yet U.S. psychiatry continues to advocate for involuntary commitment, forced drugging, and electroshock, including on minors.

"This biomedical model has failed not only patients but public trust," said Eastgate. "It has resulted in a mental health system plagued by poor and lethal outcomes and human rights violations."

CCHR, which was established in 1969 by the Church of Scientology and world-renowned psychiatrist and author, Prof. Thomas Szasz, is now calling on:

• Federal and state lawmakers to adopt the WHO standards and enact legal protections against coercive practices
• Oversight bodies to mandate full transparency from all psychiatric facilities
• Licensing boards to enforce patient rights and prosecute rights violations

"This is a moment of reckoning for psychiatry," Eastgate concluded. "The evidence of harm is overwhelming. The guidance for reform is clear. Now, it is up to the U.S. to either embrace change—or be held responsible for the continued suffering of those entrusted to its care."

Sources:

[1] David Robinson, "Why did 14K people die with ties to hospital restraints amid pandemic?," Democrat & Chronicle, New York State team, 17 July 2024, www.democratandchronicle.com/story/news/2024/07/17/why-did-14k-people-die-with-ties-to-hospital-restraints-amid-pandemic/73602950007/

[2] Morris, N, "Involuntary Commitments: Billing Patients for Forced Psychiatric Care," Am J Psychiatry, 1 Dec 2020, psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030319

[3] www.samhsa.gov/data/report/national-mental-health-services-survey-n-mhss-2018-data-mental-health-treatment-facilities