World Health Organization New Guidelines are Vital to End Coercive Psychiatric Practices & Abuse

Coercion is built into mental health systems, including in professional education and training, and is reinforced through national mental health and other legislation. – World Health Organization

WHO report vindicates CCHR and the many groups that have fought worldwide for the recognition of psychiatric human rights violations, including involuntary commitment and forced electroshock and other biomedical, including drug treatments.

By Jan Eastgate
President, CCHR International
June 11, 2021
Updated: May 9, 2022

The World Health Organization (WHO) has released a damning report that lashes out against coercive psychiatric practices, which it says “are pervasive and are increasingly used in services in countries around the world, despite the lack of evidence that they offer any benefits, and the significant evidence that they lead to physical and psychological harm and even death.”[1] It points to the United Nations Convention on the Rights of Persons with Disabilities (CRPD) which in essence, calls for a ban on “forced hospitalization and forced treatment.”[2]

Citizens Commission on Human Rights International welcomes the report not just for it recognizing psychiatric abuses and torture as being rife, but also as a vindication of CCHR’s efforts since 1969 and other groups that have fought for the recognition of patents’ rights violations that WHO now acknowledges. CCHR’s Mental Health Declaration of Human Rights, written in 1969, includes many of the rights that the W.H.O. report now addresses. [3]

 
For example, WHO points to a series of UN guidelines and Human Rights Council resolutions that have called on countries to tackle the “unlawful or arbitrary institutionalization, overmedication and treatment practices [seen in the field of mental health] that fail to respect… autonomy, will and preferences.”[4] People who are subjected to coercive practices report feelings of dehumanization, disempowerment and being disrespected, WHO further states.[5]

CRPD says patients must not be put at risk of “torture or cruel, inhuman or degrading treatment or punishment” and recommends prohibiting “coercive practices such as forced admission and treatment, seclusion and restraint, as well as the administering of antipsychotic medication, electroconvulsive therapy (ECT) and psychosurgery without informed consent.”[6]

Coercive Practices Create Harm

Psychiatry has failed to take responsibility for the fact that its own coercive practices have caused the stigmatization which drives medical students and patients away from it, while it tries to blame this on its critics. WHO says stigmatization exists among the general population, policy makers and others when they see those with mental disabilities as being “at risk of harming themselves or others, or that they need medical treatment to keep them safe”—a psychiatric mantra—which results in a general acceptance of coercive practices such as involuntary admission and treatment or seclusion and restraint.[7]

Abusive practices CCHR has documented include:

  • In the U.S., children—who are too young to consent to electroshock—are subjected to it, even at the age of five or younger. American psychiatrists are administering it despite W.H.O. reporting sixteen years ago that “There are no indications for the use of ECT on minors, and hence this should be prohibited through legislation.” Yet the American Psychiatric Association has called for greater use of this brain-damaging, barbaric practice on minors.[8]
  • Many patients are forcibly detained and drugged under U.S. involuntary commitment laws, and with telepsychiatry now available, psychiatric hospitals are using this to incarcerate people against their will for their insurance.
  • Recent reports of the troubled teen industry in the U.S. highlight how coercive restraint use in psychiatric and behavioral facilities is common, despite leading to deaths of youths, without accountability. Teenagers gasping for air, crying out that they “can’t breathe” have died undergoing restraint to control their behavior.[9]
  • In New Zealand, a Royal Commission Inquiry into Child Abuse begins its investigation on June 14 into the torture of children with an electroshock device at the now-closed state psychiatric institution, Lake Alice. Children were not anesthetized but punitively shocked directly to various body parts, including genitalia.[10]
  • Despite a March 2020 Food and Drug Administration ban on a similar shock device used at the Judge Rotenberg Center in Massachusetts for behavior modification, the torturous procedure is still being used.[11]
  • Until recently, psychiatrists such as Patrick McGorry in Australia, pre-drugged patients in the Brave New World theory that this could prevent them from becoming psychotic, yet the antipsychotics prescribed for this list psychosis as a side effect. Similar practices are researched in the U.S.[12]

Many U.S. states allow electroshock to be given to involuntary patients against their will, constituting torture, as UN agencies have clearly stated. The WHO report specifically highlights the problem that “coercive practices are used in some cases because they are mandated in the national [or state] laws of countries.”[13]

Further, coercion is “built into mental health systems, including in professional education and training, and is reinforced through national mental health and other legislation.”[14]

These laws need to change, similar to those enacted in Australia where criminal penalties are enshrined in several mental health laws, should certain psychiatric treatments be administered, violating patients’ rights.

Countries must also ensure that “informed consent” is in place and that “the right to refuse admission and treatment is also respected.”[15] “People wishing to come off psychotropic drugs should also be actively supported to do so, and several recent resources have been developed to support people to achieve this,” WHO says.[16]

No Accountability: No Funding

WHO sees community mental health as the alternative to egregious hospitalization and the biomedical paradigm—psychotropic drugs, electroshock and psychosurgery—for treating people’s emotional and mental problems. This would require a massive injection of funds. However, the checks and balances do not exist to prevent abuses occurring in the community. Greater accountability, including criminal penalties are needed.

The same funding limitations also apply to psychiatric research, which the WHO highlights have been dominated by a biomedical model—neuroscience, genetics and psychopharmacology. It quotes the astounding admission from Thomas Insell, former director of the National Institute for Mental Health (2002 to 2015), who said: “When I look back on that, I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think US$ 20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”[17]

We cannot keep flooding more money into a failing and harmful mental health system, when accountability either doesn’t exist or is so ineffective that perpetrators can get away with murder.

Abolish Involuntary Hospitalization

In the U.S., in the wake of acts of senseless violence, psychiatrists have called for greater rights to involuntarily commit individuals—the antithesis of what the WHO is advocating. In fact, it debunks the idea that involuntary admission is necessary under so-called grounds such as “dangerousness” or “lack of insight.’”[18] Or that the person is “‘at risk of harming themselves or others, or that they need medical treatment to keep them safe,’” with WHO saying that such practices lead to an “over-emphasis on biomedical treatment options and a general acceptance of coercive practices such as involuntary admission and treatment or seclusion and restraint.”[19]

“Although challenging, it is important for countries…to eliminate practices that restrict the right to legal capacity, such as involuntary admission and treatment,” it says.[20]

The late Dr. Thomas Szasz, professor of psychiatry, a fellow of the American Psychiatric Association, and co-founder of CCHR, stressed this point sixty years ago. Indeed, he was more forthright in stating: “Involuntary mental hospitalization is like slavery. Refining the standards for commitment is like prettifying the slave plantations. The problem is not how to improve commitment, but how to abolish it.” Further, “The most important deprivation of human and constitutional rights inflicted upon persons said to be mentally ill is involuntary mental hospitalization….”[21] 

CCHR will continue to monitor and document psychiatric abuses and with this WHO guideline against involuntary treatment, refer this to attorneys who may be able to seek charges of torture where forced treatment is administered. Until laws enact the necessary protections, more pressure is needed to bring abuses to account through the courts.

Report psychiatric abuse to CCHR.

UN Human Rights Council Further Condemns Coercion

On the heels of the WHO guidelines, the United Nations Human Rights Council issued its report on mental health, for 28 February–1 April 2022, which further condemned coercive psychiatric practices.

The UN High Commissioner for Human Rights was asked to organize a consultation to discuss the best ways to “harmonize national laws, policies and practices relating to mental health with the norms of the Convention on the Rights of Persons with Disabilities.” This was held November 15th, 2021.

Of note, the United States signed the CRPD in 2009, showing agreement but has yet to ratify it as law.[22]

Michelle Bachelet, UN High Commissioner for Human Rights told the 2021 hearing, “Historically, people with psychosocial disabilities and with mental conditions have been wrongly deemed dangerous to themselves and others. They are still commonly institutionalized, sometimes for life; criminalized and incarcerated because of their conditions.” As such, “In line with the Convention on the Rights of Persons with Disabilities, there needs to be an urgent shift away from institutionalization and towards inclusion and the right to independent living in the community.”[23]

“That requires greater investment in community-based support services that are responsive to people’s needs,” she said.

However, what it needs is accountable services and proven, workable treatment that is not physically and mentally invasive and actually improves the lives of individuals, not worsen them—whether geographically in the community or not.

The American Psychiatric Association regularly takes positions on mental health matters, including those involving civil commitment and is the developer and publisher of the Diagnostic and Statistical Manual of Mental Disorders, the diagnoses upon which deprivation of liberty and forced treatment are often based.[24] In a 2016 position paper on involuntary commitment, the APA used disingenuous terms such as court-mandated treatment programs are often referred to as “assisted outpatient treatment,” or AOT and involuntary commitment provides a” system that’s able to provide the necessary treatment….” What often amounts to forced treatment should last at least 180 days—or more than five months—with extensions possible after judicial review, the APA recommended.[25]

Ron Honberg, J.D., national director for policy and legal affairs for the pharmaceutical company funded National Alliance on Mental Illness (NAMI) told the Psychiatric News, “The greatest value may be that IOC [involuntary outpatient commitment] fosters a collaborative approach and holds the treatment system accountable.”

But none of it—certainly not the harm it can cause—is held accountable.  And such views are contrary to the Convention on the Rights of Persons with Disabilities (CRPD).

“The CRPD prohibits discrimination against people with mental health problems, and explicitly refers to forced hospitalization and forced drugging as violations of basic human rights. Involuntary ‘treatment’ deprives a person of their freedom and bodily autonomy—without even having to be convicted of any crime.”[26]

The Judge David L. Bazelon Center for Mental Health Law in Washington, D.C., says that it “opposes all involuntary outpatient commitment as an infringement of an individual’s constitutional rights…. Such coercion undermines consumer confidence and causes many consumers to avoid contact with the mental health system altogether.”[27]

Key points raised by panel members and published in the report of the Human Rights Council forty-ninth session included the following in alignment with recommendations and general comments of the CRPD:

  • Countries need to move away from institutionalization and towards inclusion and the right to independent living in the community.
  • States should repeal provisions on forced institutionalization and end involuntary treatment practices, promoting supported decision-making and developing rights-based mental health services in the community.
  • Coercion, involuntary treatment and forced placement are incompatible with human rights.
  • There is an overreliance on mental health drugs which are a “significant obstacle to the realization of the right to health.”
  • Wide legal and policy reforms should be undertaken with a human rights-based approach.
  • WHO should develop a new, holistic list of essential psychosocial and population-based interventions.
  • States should simultaneously carry out efforts to address interconnected rights that contribute to independent living, including housing, inclusive education and employment. The focus of mental health systems and services should be widened beyond the biomedical model to include a holistic approach that considers all aspect of a person’s life.[28]

Numerous UN reports have opposed coercion in mental health.[29] Yet, despite the UN, WHO, and even the World Psychiatric Association standing against coercive psychiatry, there are still efforts in Europe and elsewhere to increase involuntary commitment measures.

In various reports adopted between 2018 and 2020, the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health spoke out against the involuntary placement of persons with intellectual and psychosocial disabilities to mental health facilities, and excessive medicalization and discriminatory mental health laws that deprive people of liberty and their autonomy, often based on the myth that “individuals with certain diagnoses are at high risk of perpetuating violence and posing a threat to the public.”[30]

In its 2020 report on “Mental Health and Human Rights: Setting a Rights-based Global Agenda,” the Rapporteur called States to “undertake the legislative, policy and other measures required to fully implement a human rights-based approach to mental health with the inclusive participation of those with lived experience.”[31]

The current UN Human Rights Council report ends by urging all States parties to the CRPD should review their obligations before adopting legislation or instruments that may contradict their obligations. In particular, “States are urged to re-examine from this perspective the draft additional protocol to the Oviedo Convention currently under consideration by the Council of Europe and to consider opposing its adoption and requesting its withdrawal.”[32] The Council of Europe Bioethics Committee (DH-BIO) is the body commissioned to issue recommendations on human rights in the field of biomedicine.[33]

The Oviedo Convention was originally opened for signature on 4 April 1997 in Oviedo, Spain and is thus otherwise known as the Oviedo Convention and entered into force on 1 December 1999.[34]

Since 2014, the Bioethics Committee has been developing an additional protocol to standardize involuntary treatment across Europe under the “Oviedo Convention” concerning the protection of human rights and dignity of persons with mental disorder regarding involuntary placement and involuntary treatment.[35]

The final version of the new protocol reiterates the key criteria used in involuntary commitment, such as the existence of danger to oneself or others but attributes an even stronger role to the examining “practitioner.” Only one evaluation is required, and the same “practitioner” plays a key role in prolonging involuntary treatment over time.[36]

This, despite it recognizing in 2018 that the “use of involuntary placement and involuntary treatment has the potential to endanger human dignity and fundamental rights and freedoms and must therefore be minimized and only be used as a last resort.”[37]

Under the 2018 draft, “involuntary” refers to a placement or treatment applied to a person with mental disorder who objects to the measure; “involuntary measure” refers to involuntary placement and/or involuntary treatment; “seclusion” refers to the involuntary keeping of a person alone in a room or designated area; “restraint” refers to the use of physical, mechanical or pharmaceutical means aiming at holding or immobilizing a person or controlling his or her movements.”[38]

According to a December 2021 article on this, “Despite a wide outcry by civil society organizations and UN experts such as the UN CRPD Committee and the UN Special Rapporteurs on the Rights of Persons with Disabilities and the Right to Health, the DH-BIO voted to move forward with the draft protocol, with 28 in favor, 7 abstentions and 1 against. If adopted at the Council of Europe, it could lead to further friction with international law and cement the use of coercion in psychiatry.”[39]

Mental Health Europe opposed it because:

  • Involuntary treatment and placement in psychiatry are prohibited under the UN Convention on the Rights of Persons with Disabilities (CRPD).
  • The adoption will create a legal conflict between the obligations of States under the regional level (Council of Europe) and the international level (CRPD). Two different standards will apply in European States that ratified the CRPD.
  • It risks solidifying institutionalization and increase coercion in psychiatry. The practice is condemned by the CRPD and the Special Rapporteur on the Rights of Persons with Disabilities.[40]

The UN Committee on the Rights of Persons with Disabilities (the Committee) clarified the absolute prohibition of involuntary placement and treatment of persons with disabilities under the Convention in its Guidelines on the right to liberty and security of persons with disabilities and recommendations to States parties.

The Convention requires States parties to “repeal provisions that allow for the involuntary commitment of persons with disabilities in mental health institutions based on actual or perceived impairment.”

The Committee found that the use of forced treatment, seclusion and various methods of restraint in medical facilities, including physical, chemical and mechanical restraints are not consistent with the prohibition of torture and other cruel, inhuman or degrading treatment or punishment of persons with disabilities (article 15 CRPD).[41]

The absolute prohibition of involuntary placement and treatment in psychiatry was reiterated in the Statement by the Committee calling States parties to oppose the draft Additional Protocol to the Oviedo Convention adopted during the Committee’s 20th session, held, from 27 August to 21 September 2018 in Geneva. The Committee indicated that the draft additional protocol to the Oviedo Convention “violates particularly article 5 on equality and non-discrimination in conjunction with articles 12 on the right of equal recognition before the law, article 14 on the right to liberty and security, article 17 on the right to physical and mental integrity, and article 25 on the right to health.”[42]

In a resolution on mental health and human rights adopted in March 2020, the UN Human Rights Council (A/HRC/43/L.19) expressed deep concerns that persons with mental health problems and/or psychosocial disabilities, including persons using mental health services, continue to be subject to a variety of human rights violations, including over-medicalization and treatment practices that fail to respect their autonomy, will and preferences.

The Special Rapporteur on the right to health welcomed “increasing recognition that there is no health without mental health but highlights the continuous global failure of the status quo to address human rights violations in mental healthcare systems that reinforce a vicious cycle of discrimination, disempowerment, coercion, social exclusion and injustice. To end this cycle, treatment and distress must be seen more broadly and move beyond the biomedical understanding of mental health. “The expert argues that mental conditions are not like other physical conditions (e.g., bacterial meningitis) for which there are essential medicines such as antibiotics. The pathophysiology of mental conditions and the specific mechanisms by which psychotropic drugs may be effective are unknown.”[43]

Any strengthening of involuntary commitment laws is contrary to achieving human rights in the field of mental health.

On July 6th, 2020, Dr. Pūras, addressed the UN Human Rights Council: “The global mental health status quo should move away from the outdated ‘mad or bad’ approach which seeks to prevent behaviors deemed as ‘dangerous’ or provide treatment considered ‘medically necessary’ without consent.” Dr. Pūras said that the dominance of the biomedical model has resulted in an overuse of medicalization and institutionalization. He warned against the exaggerated benefits of psychotropic medications and highlighted that their effectiveness is not comparable to other medicines that are essential for certain physical conditions, such as for example, antibiotics for bacterial infections.” Further, “there are no biological markers for mental health conditions,” he said. Hence the specific mechanisms by which psychotropic drugs might be effective, are simply unknown.”[44]

Suicide prevention should not be addressed by increased prescription of medication, Dr. Pūras stated in a statement for World Mental Health Day on October 9th, 2019. “Emotional pain frequently comes from being a victim of violence, discrimination or exclusion. Targeting the brain chemistry of individuals often exacerbates stigma and social exclusion, aggravates loneliness and helplessness and fails to reduce the risk of suicide,” said Pūras in his statement. Further, “Pathologizing the diversity of individual responses to adversity as if they were medical conditions disempowers individuals and perpetuates social exclusion and stigma.”

“We must pursue new routes to suicide prevention that invest in fortifying healthy, respectful and trusting relationships which also include connecting people with communities.

“Suicide prevention must address the structural factors that make lives unlivable and examine how distress arises within power imbalances; it must also address problem relationships and reduce interpersonal violence.” “To prevent suicide, States should adopt strategies with a rights-based approach that avoids excessive medicalization and addresses societal determinants, promoting autonomy and resilience through social connection, tolerance, justice, and healthy relationships.”[45]

On mental health-care systems generally, Dr. Pūras said many residential institutions and psychiatric hospitals too often breed cultures of violence, stigmatization and helplessness. “Efforts should be refocused towards non-coercive alternatives that address holistic well-being, and place individuals and their definition of their experiences, and their decisions, at the center.”[46]

CCHR’s Mental Health Declaration of Human Rights penned in 1969 is becoming a reality with the right-based directions being taken by UN bodies and supporting organizations. The need for global acceptance of the Mental Health Declaration of Human Rights is made clear because virtually no human or civil rights are granted to those psychiatry deems mentally ill,  no medical or scientific tests exist to conclusively prove anyone is mentally diseased, and no guidelines –until recently–existed to protect citizens from abuses committed under the guise of mental health.

Brief Time Line

CCHR was established in 1969 in the spirit of the Declaration, especially Article 5: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.”

2013: The report of Juan E. Méndez, then UN Special Rapporteur on Torture, called for “an absolute ban on all forced and non-consensual medical interventions” such as “electroshock and mind-altering drugs….”[47]

2015: United Nations Committee on the Rights of the Child commended that governments “take the necessary measures to prevent any pressure on children and parents to accept treatment with psychostimulant drugs.”[48]

2015: The UN Committee Against Torture condemned the psychiatric torture of children at Lake Alice hospital in New Zealand. It said that “the state [NZ] party failed to investigate or hold any individual accountable for the nearly 200 allegations of torture and ill-treatment against minors at Lake Alice Hospital” in the 1970s. It reiterated this in another report in 2019.[49]

2015–2017: Two UN Special Rapporteurs on Torture condemned Judge Rotenberg Center’s Applied Behavior Analysis electroshock (skin shock behavior modification) “torture” in Massachusetts.[50] In 2018, the Inter-American Commission on Human Rights (IACHR) also issued a formal notice that called for immediate cessation of the electric shocks at JRC. In a seven-page resolution, the Washington-based panel said that the practice poses a “serious impact on the rights” of the vulnerable children, “particularly on their right to personal integrity which may be subjected to a form of torture.”[51]

July 2016: Human Rights Council Resolution A/HRC/RES/32/18 recognized the need to fully integrate a human rights perspective into mental health and community services to eliminate violence and discrimination while promoting inclusion and participation. It spoke of being deeply concerned that “persons with mental health conditions or psychosocial disabilities, in particular persons using mental health services, may be subject to, inter alia, widespread discrimination, stigma, prejudice, violence, social exclusion and segregation, unlawful or arbitrary institutionalization, overmedicalization and treatment practices that fail to respect their autonomy, will and preferences.”[52]

June 6th–23rd, 2017: The “ground-breaking” (A/HRC/35/21) report to the Human Rights Council, elaborated on the “status quo, which is preoccupied with the excessive use of biomedical treatments and non-consensual measures.”

  • Point 24: “The status quo in current psychiatry, based on power asymmetries, leads to the mistrust of many users and threatens and undermines the reputation of the psychiatric profession.”
  • Point 33: “The Committee on the Rights of Persons with Disabilities emphasizes full respect for legal capacity, the absolute prohibition of involuntary detention based on impairment and the elimination of forced treatment (see A/HRC/34/32, paras. 22-33).
  • Point 63: “The right to provide consent to treatment and hospitalization includes the right to refuse treatment… The right to provide consent to treatment and hospitalization includes the right to refuse treatment.”
  • Point 64: The abuse of biomedical interventions, including the inappropriate use or over prescription of psychotropic medications and the use of coercion and forced admissions, compromise the right to quality care.” Further, “Justification for using coercion is generally based on “medical necessity” and “dangerousness.” These subjective principles are not supported by research and their application is open to broad interpretation, raising questions of arbitrariness that has come under increasing legal scrutiny. ‘Dangerousness’ is often based on inappropriate prejudice, rather than evidence. There also exist compelling arguments that forced treatment, including with psychotropic medications, is not effective, despite its widespread use.”
  • Point 65: “…immediate action is required to radically reduce medical coercion and facilitate the move towards an end to all forced psychiatric treatment and confinement.”
  • Point 81: “The interventions used to address serious cases are perhaps the biggest indictment of the biomedical tradition. Coercion, medicalization and exclusion, which are vestiges of traditional psychiatric care relationships, must be replaced with a modern understanding of recovery and evidence-based services that restore dignity and return rights holders to their families and communities. People can and do recover from even the most severe mental health conditions and go on to live full and rich lives.”
  • Point 94 (f): “Take targeted, concrete measures to radically reduce medical coercion and facilitate the move towards an end to all forced psychiatric treatment and confinement….”[53]

October 2017: Dr. Danius Pūras, UN Special Rapporteur on Health condemned coercive psychiatry to “end decades of neglect, abuse and violence.” Further, “There is now unequivocal evidence of the failures of a system that relies too heavily on the biomedical model of mental health services, including the front-line and excessive use of psychotropic medicines, and yet these models persist.”[54]

July 2018: UN Human Rights Council report on “Mental health and human rights,” also called on governments to recognize that forced psychiatric treatment, including ECT, “as practices constituting torture or other cruel, inhuman or degrading treatment or punishment….”[55]

June–July 2019: The annual report to the Human Rights Council (A/HRC/41/34) elaborated on the critical role of the social determinants of mental health. “Right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Point 84: “If too much is expected from and invested in high-risk interventions, this can reinforce ineffective and coercive practices, such as involuntary hospitalization and treatment, excessive use of psychotropic medications and social exclusion.”[56]

October 9, 2019: World Mental Health Day. Dr. Pūras advised adopting strategies with a rights-based approach that avoids excessive medicalization and addresses societal determinants. [57]

January 2020: The UN Committee against Torture condemned the use of electroshock as torture on children treated at Lake Alice psychiatric hospital in New Zealand in the 1970s. The committee heavily criticized successive governments for repeatedly failing to properly investigate undisputed historic allegations of torture of children at the psychiatric hospital.[58]

April 15, 2020: Special Rapporteur on the right to health report to Human Rights Council’s 45th session (A/HRC/44/48) highlighting “the continuous global failure of the status quo to address human rights violations in mental healthcare systems that reinforce a vicious cycle of discrimination, disempowerment, coercion, social exclusion and injustice. To end this cycle, treatment and distress must be seen more broadly and move beyond the biomedical understanding of mental health.”[59]

June 19, 2020: Resolution (43/13) was adopted by the Human Rights Council and reported in the Human Rights Council 43rd session 24 February–13 March and 15–23 June 2020. This reaffirmed many earlier UN Declarations, guidelines etc. on mental health/disabilities. “The absence of community-based mental health holistic support in many parts of the world means the only support available is in psychiatric institutions, which are associated with gross human rights violations, such as degrading treatment and abuse, violence, including seclusion, isolation and restraint, used as punishment and coercion, and many other violations spanning basic civil, cultural, economic, political, and social rights.”[60]

October 2020: The World Psychiatric Association issued a Position Statement, “Implementing Alternatives to Coercion: A Key Component of Improving Mental Health Care.” It said coercion in psychiatry is “over-used,” contravening patients’ rights, including violations of “rights to liberty; autonomy; freedom from torture, inhuman or degrading treatment….”[61]

June 10, 2021: The World Health Organization’s “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” condemns coercive psychiatric practices, which it says, “are pervasive and are increasingly used in services in countries around the world, despite the lack of evidence that they offer any benefits, and the significant evidence that they lead to physical and psychological harm and even death.”[62]

November 15, 2021: Consultation on mental health and human rights held. Michelle Bachelet, UN High Commissioner for Human Rights issued comments on the pandemic having had “a major impact on mental health and wellbeing across societies.” And so, this has the urgency for us, as a global community, “to promote a paradigm shift in mental health and to adopt, implement, update, strengthen or monitor, as appropriate, all existing laws, policies and practices.”

Feb 28-April 1, 2022: Report of the United Nations High Commissioner for Human Rights, Human Rights Council, 49th session to make “mental health” a global priority. Coercion, involuntary treatment and forced placement are outdated, ineffective and incompatible with human rights. States should repeal provisions on forced institutionalization and substituted decision-making in law and in practice.[63]

References:

[1] “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, p. 8, https://www.who.int/publications/i/item/9789240025707 (to download report)

[2] Ibid., p. 4

[3] https://www.cchrint.org/about-us/declaration-of-human-rights/

[4] Ibid., p. 5

[5] Ibid., p. 8

[6] Ibid., p. 7

[7] Ibid., p. 3

[8] Letter to Robert M. Califf, M.D., Commissioner, U.S. Food and Drug Administration, from the American Psychiatric Association, March 10, 2016, https://psychiatry.org/File%20Library/Psychiatrists/Advocacy/Federal/APA-FDA-ECT-reclassification-comments-03102016.pdf

[9] https://www.cchrint.org/2021/03/24/cchr-laws-inadequate-to-safeguard-troubled-teens-from-psychiatric-abuse/; https://www.cchrint.org/2021/02/17/utah-state-law-curbing-behavioral-restraint-use-on-children-youths-is-applauded-but-unconditional-ban-is-needed-nationwide/

[10] https://www.cchrint.org/2021/03/09/cchr-us-should-mirror-nz-child-shock-treatment-inquiry-to-ban-therapy/

[11] https://www.cchrint.org/2021/03/09/cchr-us-should-mirror-nz-child-shock-treatment-inquiry-to-ban-therapy/

[12] https://www.cchrint.org/2010/06/16/australian-psychiatrist-patrick-mcgorry-wants-his-pre-drugging-agenda-to-go-global/

[13] Op. cit., World Health Organization, p. 8

[14] Ibid., p. 8

[15] Ibid., p. 6

[16] Ibid., p. 201

[17] Ibid., p. 215

[18] Ibid., p. 7

[19] Ibid., p. 3

[20] Ibid., p. 6

[21] https://www.cchrint.org/about-us/co-founder-dr-thomas-szasz/quotes-on-involuntary-commitment/

[22] http://www.iustitialegalcenter.org/us-ratification-of-the-crpd

[23] Michelle Bachelet, UN High Commissioner for Human Rights, “Building Bridges and Intercultural Dialogue seminar: Bridge building igniting youth action for unity in diversity,” Human rights Council Intersessional consultation on Mental Health and Human Rights, 15 Nov, 2021, https://www.ohchr.org/en/statements/2021/11/bachelet-calls-mental-health-care-be-based-human-rights

[24] Robert a Brooks, “Psychiatrists’ Opinions About Involuntary Civil Commitment: Results of a National Survey,” Journal of the American Academy of Psychiatry and the Law Online June 2007, 35 (2) 219-228

http://jaapl.org/content/35/2/219

[25] Aaron Levin, “APA Board Approves Position Statement on Involuntary Outpatient Commitment,” Psychiatric News, 29 Feb. 2016, https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.3a10

[26] https://www.madinamerica.com/2021/12/mental-health-care-consent-human-rights/

[27] Op. cit., Aaron Levin, Psychiatric News

[28] Annual report of the United Nations High Commissioner for Human Rights and reports of the Office of the High Commissioner and the Secretary-General, 49th session, Human Rights Council, “Summary of the outcome of the consultation on ways to harmonize laws, policies and practices relating to mental health with the norms of the Convention on the Rights of Persons with Disabilities and on how to implement them,” 28 February–1 April 2022

[29] “The right to mental health,” UN Office of the High Commissioner, https://previous.ohchr.org/EN/Issues/Health/Pages/RightToMentalHealth.aspx

[30] “Third Party Intervention in relation to the European Court of Human Rights’ Advisory Opinion on Oviedo Convention,” November 2020, Written comments jointly submitted by: Autism Europe, European Disability Forum, Inclusion Europe, International Disability Alliance and Mental Health Europe, citing:  Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health on “The role of the determinants of health in advancing the right to mental health” (A/HRC/41/34), paragraph 50

[31] Ibid., “Third Party Intervention…,” citing: Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health on “Mental Health and Human Rights: Setting a Rights-based Global Agenda” (A/HRC/44/48), paragraph 86(a), 15 Apr. 2020, https://www.ohchr.org/en/special-procedures/sr-health/human-rights-based-global-agenda-mental-health-and-human-rights

[32] Op. cit., Annual report of the United Nations High Commissioner

[33] https://www.mhe-sme.org/what-we-do/human-rights/withdraw-oviedo/

[34] https://www.coe.int/en/web/bioethics/oviedo-convention

[35] https://www.mhe-sme.org/what-we-do/human-rights/withdraw-oviedo/

[36] Laura Marchetti, “Mental Health Care Must Support Consent and Basic Human Rights,” Mad in America, 11 Dec. 2021, https://www.madinamerica.com/2021/12/mental-health-care-consent-human-rights/

[37] COMMITTEE ON BIOETHICS (DH-BIO) Draft Additional Protocol concerning the protection of human rights and dignity of persons with mental disorder with regard to involuntary placement and involuntary treatment, 4 June 2018, Council of Europe DH-BIO/INF (2018) 7, https://rm.coe.int/inf-2018-7-psy-draft-prot-e/16808c58a3

[38] Ibid.

[39] Op. cit., Laura Marchetti, Mad in America

[40] https://www.mhe-sme.org/what-we-do/human-rights/withdraw-oviedo/

[41] Op. cit., “Third Party Intervention…”

[42] Ibid.

[43] “A human rights-based global agenda for mental health and human rights,” A/HRC/44/48, Human Rights Council’s 45th session, 15 Apr. 2020, https://www.ohchr.org/en/special-procedures/sr-health/human-rights-based-global-agenda-mental-health-and-human-rights

[44] “The world must change the way mental health challenges are addressed, UN expert says,” UN Human Rights Office of the High Commissioner, 6 July 2020, https://previous.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=26039&LangID=E

[45] “Major changes to suicide prevention needed, with rights-based approach to make life “more liveable” — UN expert,” UN Human Rights Office of the High Commissioner, 10 Oct. 2019, https://previous.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=25118&LangID=E

[46] “UN expert highlights importance of social relationships for mental health and well-being,” ,” UN Human Rights Office of the High Commissioner, 24 June 2019, https://previous.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=24731&LangID=E

[47] https://www.cchrint.org/2020/12/10/un-human-rights-day-should-tackle-cruel-inhuman-psychiatric-treatment/#_edn13, citing: A/HRC/22/53, “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez,” United Nations, General Assembly, Human Rights Council, Twenty-second Session, Agenda Item 3, 1 Feb. 2013, p. 23, https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf

[48] https://www.cchrint.org/2022/01/03/cchr-renews-pledge-for-child-protections-against-psychiatric-abuse-in-2022/#_edn7, citing: UNCRC report to Sweden, 2015

[49] Aaron Smale, “UN condemns NZ’s response to Lake Alice torture: Official investigations into abuse at Lake Alice psychiatric hospital were effectively a sham, UN finds,” Newsroom (NZ), 7 Jan. 2020, https://www.newsroom.co.nz/2020/01/07/975575/un-condemns-nzs-response-to-lake-alice-torture

[50] https://rewardandconsent.blogspot.com/2015/10/2014-cnn-reportinterview-un-special.html

[51] “Human rights body calls on US school to ban electric shocks on children,” The Guardian, 18 Dec. 2018, https://www.theguardian.com/us-news/2018/dec/18/judge-rotenberg-center-electric-shocks-ban-inter-american-commission-human-rights; https://www.documentcloud.org/documents/5632074-Resolution-86-2018-PM-1357-18-US.html.

[52] “Resolution adopted by the Human Rights Council on 1 July,” Human Rights Council Thirty-second session, 18 July 2016, https://previous.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=24731&LangID=E

[53] https://previous.ohchr.org/EN/Issues/Health/Pages/RightToMentalHealth.aspx; “Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” Thirty-fifth session 6-23 June 2017, 28 Mar. 2017

[54] https://www.cchrint.org/2021/03/08/resource-on-why-psychiatry-is-upset-about-its-failures-and-critics/, citing: “World needs ‘revolution’ in mental health care – UN rights expert,” 2017, http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21689&LangID=E#sthash.MMIxDbIx.dpuf; A/HRC/35/21, “Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development,” Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Human Rights Council Thirty-fifth session, Agenda item 3, 6-23 June 2017, available at: https://digitallibrary.un.org/record/1298436?ln=en

[55] https://www.cchrint.org/2020/12/10/un-human-rights-day-should-tackle-cruel-inhuman-psychiatric-treatment/#_edn14, Mental health and human rights:  Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development,” Annual report of the United Nations High Commissioner for Human Rights and reports of the Office of the High Commissioner and the Secretary-General, Human Rights Council, 10-28 Sept. 2018, p. 14, point 46

[56] A/HRC/41/34, “Right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” Human Rights Council, Forty-first session 24 June–12 July 2019, 12 Apr. 2019

[57] Op. cit., UN Human Rights Office of the High Commissioner, 10 Oct. 2019

[58] Aaron Smale, “UN condemns NZ’s response to Lake Alice torture: Official investigations into abuse at Lake Alice psychiatric hospital were effectively a sham, UN finds,” Newsroom (NZ), 7 Jan. 2020, https://www.newsroom.co.nz/2020/01/07/975575/un-condemns-nzs-response-to-lake-alice-torture

[59]Op. cit., Special Rapporteur on the right to health report to Human Rights Council’s 45th session, 15 Apr. 2020; “Right of everyone to the enjoyment of the highest attainable standard of physical and mental health Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” UN General Assembly Human Rights Council Forty-fourth session 15 June–3 July 2020;

[60] “Mental health and human rights: OHCHR and the right to health,” UN Human Rights Office of the High Commissioner, https://www.ohchr.org/en/health/mental-health-and-human-rights

[61] https://www.cchrint.org/2021/06/07/un-special-rapporteur-dainius-puras-addresses-psychiatrys-global-coercion-crisis/#_edn3, citing: “Supporting and implementing alternatives to coercion in mental health care,” World Psychiatric Assoc., https://www.wpanet.org/alternatives-to-coercion

[62] “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, https://www.who.int/publications/i/item/9789240025707 (to download report)

[63] Op. cit., Annual report of the United Nations High Commissioner