The World Health Organization (WHO) has released a new practical guide, Supporting the Transition to Community-Based Mental Health and Social Care: Practical Guide to the Deinstitutionalization of Psychiatric Hospitals, which warns that institutional psychiatric treatment can separate people from their communities, limit their autonomy, and expose them to risks of human rights violations. According to the guidance, nearly half of people living in large psychiatric hospitals and social care institutions are held against their will for months, years, or even decades. In response, Citizens Commission on Human Rights International (CCHR) is calling on U.S. state mental health departments to adopt the policy and lead the world toward human rights-based systems.
The implications for U.S. mental health policy are significant. Every year, more than 1.2 million Americans are involuntarily committed to psychiatric facilities—about two every minute. A Harvard School of Public Health study cited in the release indicates that psychiatric hospitals continue to abuse the incarcerated, using forced electroshock, chemical restraints, and prolonged mechanical restraint—practices that violate the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT), which the U.S. has ratified. This underscores a pressing human rights crisis that demands immediate attention.
Despite growing recognition that coercive psychiatric detention and treatment harm autonomy and human rights, the United States is moving in the opposite direction. The American Bar Association has stated that a human rights-centered approach requires shifting away from primarily medicalized responses toward person-centered support and systemic change, noting that "rather than empowering individuals and dismantling coercive regimes, legislative reforms have often become procedural formalities that legitimize restrictive interventions under the guise of legal protection." A 2021 national study of data from 2011 to 2018 across 25 states found wide variation in rates of involuntary psychiatric detention—from 29 per 100,000 in Connecticut to 966 per 100,000 in Florida, a 33-fold difference. Consistent with international trends, most of the 22 states with six or more years of data recorded increases over time.
Jan Eastgate, president of CCHR International, said: "It is absurd that a U.S. mental health system already costing $280 billion a year continues to pour billions into locking people up, restraining them, and forcing drugs and electroshock that have never been conclusively shown to help—and can leave the individual worse: traumatized, injured, or dead. Every person subjected to that coercion is a human rights abuse. The billions spent doing it are also an enormous and senseless financial drain."
The WHO guidance emphasizes that deinstitutionalization is essential to building a rights-based mental health system and outlines key steps. It notes that psychiatric hospitals continue to dominate mental health systems in many countries, often marked by excessive rules and widespread coercive measures, including forced medication, mechanical restraint, and seclusion. The guidance calls for hospitals to assess quality and human rights conditions, reduce institutional practices, and end violations such as electroconvulsive therapy without anesthesia. It also urges governments to review and revise involuntary commitment criteria to align with human rights standards, promote rights-based approaches, provide access to legal advocacy, and implement policies to prevent coercion, restraint, seclusion, and violence.
CCHR urges every U.S. state mental health department and legislature to act now by reviewing and revising involuntary commitment criteria, cutting funding to involuntary detention, and reforming hospital practices to align with human rights. By implementing these changes, U.S. states can reverse the current trend toward greater coercion, restore autonomy and dignity, and set a global example of rights-based mental health systems.
