New WHO Mental Health Guideline Condemns Coercive Psychiatric Practices

New WHO Mental Health Guideline Condemns Coercive Psychiatric Practices
Accountability is an important component of the human rights framework. Without accountability, human rights lack enforcement and are rendered meaningless. – World Health Organization Draft Guidance on Mental Health, Human Rights, and Legislation

CCHR demands that governments commit to WHO’s “zero coercion” policy in mental health, and put an end to forced institutionalization and treatments.

By CCHR International
Mental Health Industry Watchdog
September 18, 2023

The World Health Organization (WHO) and the United Nations Office of the High Commissioner for Human Rights (OHCHR) have issued a draft guidance on Mental Health, Human Rights, and Legislation, with recommendations to eliminate coercive mental health practices.[1] CCHR applauds the guideline—many of the proposed reforms need urgent implementation worldwide, especially in the U.S. where patients are forced to undergo electroshock and take psychotropic drugs and are detained in behavioral and psychiatric facilities where poor conditions endanger their lives. The guideline calls on governments to “commit by law to a ‘zero coercion’ policy.”

CCHR research estimates that globally, every 30 seconds someone is involuntarily committed to a psychiatric hospital. In the U.S., according to David Cohen, a professor of social welfare at the Luskin School in California, involuntary psychiatric detentions outpaced population growth by a rate of 3 to 1 on average in recent years.[2] A study published in The American Journal of Psychiatry citing figures from 2014 suggests that involuntary hospitalizations account for 54% of admissions to psychiatric inpatient settings.[3] CCHR says it is important to note that once committed, an individual can be forced to undergo damaging treatment, without recourse.

In June 2022, WHO and OHCHR issued the groundbreaking draft guidance to protect the human rights of people in the mental health system, aimed as a resource for governments considering legislative measures to support the transformation of mental health systems to align with international human rights law.[4] CCHR’s European office submitted input to the guidelines, as recognized by WHO.[5] The final guidelines will be released on October 9.

“Coercion remains a core component of existing mental health laws across jurisdictions and is a major concern,” the guidance report says. “These may include involuntary hospitalization, involuntary medication, involuntary electroconvulsive therapy (ECT), seclusion, and physical, chemical and mechanical restraint.” Further, “They can inflict severe pain and suffering on a person with long-lasting physical and mental health consequences, which can impede recovery and lead to substantial trauma and even death.”

Jan Eastgate, president of CCHR International, says the guideline is one of the strongest documents ever to condemn what WHO calls “the pernicious effects of institutionalization, the over-emphasis on biomedical approaches and treatment options, and the use of involuntary psychiatric interventions.”

In the U.S., 76.9 million Americans take psychiatric drugs.[6] The draft report highlights how this biomedical model “works to the detriment of other holistic and person-centered and rights-based approaches and strategies.” In another 2021 guideline, WHO quoted former National Institute for Mental Health director, Thomas Insel, admitting that despite $20 billion being spent on mental health research, including biomedical, it hadn’t “moved the needle in reducing suicide, reducing hospitalizations” or “improving recovery.”[7] “A damning admission of failure,” Eastgate says, “that stems from the unscientific basis of psychiatric diagnoses and unworkable biomedical treatments in a system fraught with abuse passed off as ‘mental health care.’”

The draft guideline condemns common coercive practices such as “forced medication, seclusion and restraints.” Restraint deaths in the U.S. have been headline news for years, especially following the death of Cornelious Frederick, a 16-year-old African-American boy on May 1, 2020. He was brutally restrained in the now-closed Lakeside Academy, a behavioral facility in Michigan because he had thrown a sandwich on the floor. A coroner ruled the death a homicide.[8] The shocking death of a 7-year-old foster care child, Ja’Ceon Terry after he was restrained at Brooklawn psychiatric residential center in Louisville, Kentucky on July 17, 2022, exemplified patient abuse. The medical examiner also ruled his death a homicide.[9] 

The guideline recommends: “A person must not administer to or perform on another person any of the following—(a) deep sleep therapy; b) insulin coma therapy; (c) psychosurgery; and (d) any other operation or treatment proscribed by regulations.” CCHR in Australia had lethal deep sleep therapy—often a combination of coma-producing psychotropic drugs and electroshock—banned with criminal penalties if administered, but it is not yet globally prohibited.

It also acknowledges what U.S. psychiatrists refuse to admit—that ECT causes brain damage. The report is insistent that “ECT is not recommended for children, and hence this should be prohibited through legislation,” yet in the U.S. children ages 5 or younger have been subjected to ECT, as CCHR documented.

In August 2022, in commemoration of the W.H.O. draft guidelines, CCHR posted a “MEMORANDUM: The Need for Human Rights in Mental Health Laws to End Coercive Psychiatric Practices & Abuse” on its website.[10] A resolution accompanying it, which readers can sign and forward to their legislative representative demanding reforms, points to a 2022 Harvard Law School Project on Disability in the U.S. report that reinforced what WHO says: “Institutional mental health settings, such as state-run psychiatric hospitals, routinely employ coercive forms of ‘treatment’ that are intolerable in other settings.”[11]

The U.S. has ratified the UN Convention against Torture (CAT), adopting it in domestic law, but has failed to protect Americans from torture in psychiatric-behavioral facilities. The UN Special Rapporteur against Torture stated: “It is essential that an absolute ban on all coercive and non-consensual measures, including restraint and solitary confinement of people with psychological or intellectual disabilities, should apply in all places of deprivation of liberty, including in psychiatric and social care institutions.”[12]

The draft guidelines also call on governments to ensure patients have the right to “refuse or choose an alternative medical treatment,” and to legally bind hospitals, psychiatrists and doctors to abide by patients, “advance planning options,” also called Advanced Directives or Living Wills, to prevent forced unwanted treatment. CCHR has “Psychiatric Living Will” available on its website

CCHR praised the report’s call for accountability because without it, “human rights lack enforcement and are rendered meaningless.” CCHR has long demanded criminal culpability and the guideline notes: “When a law is transgressed, legislation should provide for effective civil, administrative or criminal sanctions and reparations.”

Eastgate adds: “The need for such guidelines is a damning indictment of the psychiatric system’s failure to protect patients’ human rights and the need for its recommendations to be enacted and enforced.”

New Guidelines Create Human Rights

The following summarizes some of the key points in the draft guideline:

Ending and Prohibiting Coercive Practices:

  • Coercion is harmful in terms of both physical and mental health…When violence, coercion and abuses occur in mental health services, not only does the service fail to help people but they compound the original difficulties by retraumatizing people using the service.”
  • The Convention on the Rights of Persons with Disabilities (CRPD), which fundamentally challenges long-standing practices in mental health systems, prohibits coercive practices. It demands a transformation in the way mental health services are provided so that all persons can exercise their right to provide free and informed consent to accept or reject treatment in mental health systems. “Denial of legal capacity, coercive practices and institutionalization must end and be replaced by community-based services and supports that enable the full exercise of human rights.”
  • “There is limited evidence to support the success of coercion to reduce the risk of self-harm, facilitate access to treatment, or protect the public. Predicting self-harm or risk of harming others before the fact, apart from being ethically questionable, is extremely difficult…there is little evidence that risk assessment tools and coercive mental health treatment prevent suicide.”
  • “To ensure a complete paradigm shift of mental healthcare away from coercion, in addition to advance directives and crisis support, legislation should clearly prohibit all involuntary measures and mandate that all services, regardless of whether they are provided on an outpatient or inpatient environment, implement non-coercive interventions. No country has yet eliminated all forms of coercion in mental health systems, but there is evidence that legislative changes can help prevent involuntary commitment and support moving in this direction.”
  • “Often discriminatory practices are underpinned by legal frameworks, which fail to uphold human rights and to acknowledge the pernicious effects of institutionalization, the over-emphasis on biomedical approaches and treatment options, and the use of involuntary psychiatric interventions.”
  • “The use of any coercive measure in all mental health services is prohibited, including medical and non-medical interventions without informed consent, the use of isolation rooms and chemical and mechanical restraints, and restrictions to free movement within health services…. Shackling, chaining, seclusion, restraints, and any other form of violence, and abuse against a person with mental health conditions and psychosocial disability in the community are prohibited.”

Rights Extend to Community “Treatment”:

  • “In many countries, community treatment orders have been introduced as a way to reduce the need for hospitalization. Community treatment orders are legal orders made by courts which mandate service users to continue outpatient mental health medication and treatment. However, overwhelming evidence indicates that community treatment orders do not work; there is no evidence of decrease in hospitalization nor benefits for persons using mental health services.” (Emphasis added)
  • “Coercion within the community, including shackling, should be banned by law…. In Indonesia, Law No. 18 of 2014 on Mental Health considers shackling as a criminal offence.” 

Informed Consent & Advanced Directives:

  • “The right to informed consent is a fundamental element of the right to health. It encompasses the right to consent to, refuse or choose an alternative medical treatment.” [Emphasis added] “…no mental health treatment shall be given without the free and informed consent.”
  • Another common exception to informed consent, particularly used in mental health care, is the lack of ‘capacity’ or ‘competency’ to provide consent. As noted, this exception is contrary to the CRPD. When the will and preferences of the person in relation to a health care treatment cannot be ascertained by any means, and there are no advance directives, medical procedures should not be administered unless necessary to save a person’s life or prevent irreparable harm to their physical health. [Emphasis added]
  • Countries can adopt a higher standard for the informed consent to psychotropic drugs given their intrusive nature and potential risks of harm in the short and long term. They need to implement programs to help patients withdraw from psychiatric drugs and for health authorities to report annually “the availability of psychotropic drug discontinuation programs.”
  • Legislation should “require medical staff to inform about the right of service users to discontinue treatment and to receive support for that. Support must be provided to help people safely withdraw from drug treatment.”

Electroshock Causes Harm:

  • The report recognizes the brain-damaging effects of ECT and the “significant controversy” that surrounds its use: “In Slovenia and Luxembourg, ECT is not available; and in many countries, there has been a dramatic decline in its use. Moreover, there are calls to consider banning ECT altogether,” which CCHR insists should occur.
  • “If permitted, ECT must only be administered with the informed consent of the person concerned. International human rights standards are very clear that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment. People being offered ECT should also be made aware of all its risks and potential short- and long-term harmful effects, such as memory loss and brain damage.”
  • “ECT is not recommended for children, and hence this should be prohibited through legislation.”

Prohibiting Seclusion and Restraints:

  • In response to concerns about restraint use leading to harm and death, legislation should “prohibit the use of seclusion and restraint in any health or social care facility.” This is because “Seclusion or solitary confinement and the use of restraints, including chemical restraints, are frequently used as a way to enforce compliance to treatment and medication.”   

Biomedical-Drug Model Unworkable:

  • “…human rights violations continue to exist in mental health care settings. There is an overreliance on biomedical approaches and treatment options and inpatient services….”  Laws could foster a cultural change “away from biomedical approaches.”
  • “By allowing for broad criteria for civil commitment based on a biomedical perspective, such legislation has contributed to high rates of people being admitted to and living in institutions, condoned discrimination and human rights abuses, and entrenched barriers and neglected reform….”

Professional Responsibility and Criminal Liability:

  • “Accountability is an important component of the human rights framework. Without accountability, human rights lack enforcement and are rendered meaningless. Governments and other actors are accountable to rights holders, and mechanisms need to be established to define clear responsibilities, to measure and monitor progress, and to engage with rights-holders to improve policy-making.”
  • “Access to justice is also key to accountability. It allows persons interacting with mental health services to challenge human rights violations and to enforce rights.”
  • “When a law is transgressed, legislation should provide for effective civil, administrative or criminal sanctions and reparations. Such sanctions should be proportional to the gravity of the offences, the severity of the harm and the circumstances of each case. It is up to each country to determine the system for health and non-health related offences and penalties to be adopted for their national legislation.”

Supporting Patient Complaints:

  • “Service users should have the right to report complaints and initiate legal proceedings concerning any aspect of mental health provision. This includes any human rights violation committed….”
  • “Legislation should outline the procedure for submission, investigation and resolution of such complaints. An effective complaints procedure should be accessible, easy-to-use, time-efficient, transparent and effective. Information about complaints procedures should be prominently disseminated so that all persons using mental health services, their families and advocates are informed of its relevance, applicability, and how and where to lodge a complaint.”
  • “Legislation can also ensure that complaint adjudicators, such as national human rights institutions or courts, provide remedies that are individually tailored and include redress and reparation for the harm suffered. Victims should be entitled, whenever possible, to restitution, compensation, rehabilitation and guarantees of non-repetition.”

Monitoring Bodies Established to Prevent Abuse:

Bodies need to be established to monitor abuses and violations in the mental health field, as ultimately, they can prevent these. Such bodies should:

  • “Conduct regular and unannounced inspections of mental health settings or services, public and private, as deemed necessary. During such visits, they should have unrestricted access to all parts of the health service and service users’ medical records as well as the right to interview any person in the service in private.”
  • “Provide guidance on eliminating coercion in mental health services and monitor the implementation of such guidance.”
  • “Collect data and statistics on service provision, for example, on the duration of hospitalizations, the use of specific treatments and interventions, physical comorbidities, suicide, and natural or accidental deaths.”
  • “Monitor the application of major, invasive or irreversible interventions ensuring that these treatments are undertaken only with free and informed consent and strengthen protections from unnecessary treatments or medication.”
  • “Propose administrative and financial penalties for breach of legislative provisions, including the withdrawal of accreditation and closure.”

[1] World Health Organization, OHCHR, “Guidance on Mental Health, Human Rights and Legislation,” June 2022

[2] “Study finds involuntary psychiatric detentions on the rise,” UCLA Newsroom, 3 Nov. 2020,

[3]; “Involuntary Commitments: Billing Patients for Forced Psychiatric Care,” The American Journal. of Psychiatry, 1 Dec. 2020,




[7]; “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, p. 215,

[8]; Tyler Kingkade,” Video shows fatal restraint of Cornelius Frederick, 16, in Michigan foster facility,” NBC News, 22 July 2020,;

[9], Deborah Yetter, “7-year-old died at Kentucky youth treatment center due to suffocation, autopsy finds; 2 workers fired,” Louisville Courier Journal, 19 Sept. 2022,


[11] Matthew S. Smith & Michael Ashley Stein, “When Does Mental Health Coercion Constitute Torture?: Implications of Unpublished U.S. Immigration Judge Decisions Denying Non-Refoulement Protection,” Fordham International Law Journal, Vol 45:5, 2022,, p. 785

[12] 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. 15,