With hundreds of thousands of involuntary psychiatric holds in the U.S. annually, the mental health industry watchdog raises awareness about tools to protect against this abuse.

By CCHR International
The Mental Health Industry Watchdog
March 8, 2024

The Citizens Commission on Human Rights International, a 55-year mental health industry watchdog, says it is important for individuals to be aware of the potential risks of psychiatric treatments and how to protect themselves against the practice of involuntary commitment and forced drug and electroshock therapies. This comes in the wake of increasing reports of abuse in for-profit and state psychiatric institutions and hundreds of thousands of involuntary holds in such facilities each year.  

CCHR is raising awareness about protections against such coercion, including Advanced Medical Directives, also known as Psychiatric Living Wills, available on its website. 

Drawing attention to this are recent events where patients and former employees have accused hospitals of unlawfully detaining individuals and coercing them into treatment. In Michigan, a media investigation uncovered instances of a psychiatrist pre-signing blank clinical certificates that are used in the civil commitment process. Patients could be forcibly admitted without any evaluation, raising significant concerns about the violation of patients’ rights, and putting financial incentives above patient lives by driving prolonged hospital stays. It was estimated that Medicaid incurred substantial costs (over $24 million) due to prolonged hospital stays and potentially unnecessary treatments at the hospital.[1]

Coercion in its various guises is embedded in mental healthcare and is inconsistent with human rights-based care, according to the journal Epidemiology and Psychiatric Sciences. The authors state, “We agree that the use of compulsion in mental healthcare amounts to a ‘system failure.’”[2]

The U.S. National Institutes of Health posts an article on its website stating: “The most commonly implemented formal coercive measures include involuntary hospitalization; observation; seclusion; forced medication; mechanical, chemical, and physical restraint; as well as compulsory treatment in the community.”[3]

In the October 2023 issue of the Journal of Medical Ethics, it pointed out, “Coercive measures may lead to significant psychological and physical harm, including death.”[4] According to an article in JAMA Psychiatry, involuntary hospitalization is associated with an increased risk of suicide both during and after hospitalization.[5]

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) website also notes that the use of seclusion and restraint is “traumatizing” and that “Beyond the physical risks of injury and death, it has been found that people who experience seclusion and restraint remain in care longer and are more likely to be readmitted for care.”[6]

SAMSHA advises that “constitutional rights as recognized by the U.S. Supreme Court” include “a qualified right to refuse treatment.”[7] The Court recognized “the significant liberty interests at stake for the person facing commitment (including the stigma that accompanies commitment).”[8]

Once admitted to a psychiatric facility, patients can be forcibly drugged, a practice that disregards the long-term effects associated with psychotropic drugs, including potential permanent alterations in brain structure.[9] 

An Alaska Supreme Court decision against forced treatment acknowledged that psychotropic drugs “‘affect the mind, behavior, intellectual functions, perception, moods, and emotion’ and are known to cause a number of potentially devastating side effects….”[10]

Following violent events reported in the media, psychiatrists usually push for increased involuntary commitment and forced treatment laws. However, “most of the available evidence does not substantiate the notion that mental illness is a major risk factor for violent attacks like mass shootings….”[11] Rather, documented evidence reveals psychotropic drugs can induce violent behavior.

The Supreme Court decision points out the “lack of certainty and the fallibility of psychiatric diagnosis,” and that “there is a serious question as to whether a state could ever prove beyond a reasonable doubt that an individual is both mentally ill and likely to be dangerous.”

Despite this, patients are still subjected to drugs with devastating side effects, with hundreds of thousands of involuntary psychiatric holds occurring annually in the U.S., where this practice is most common.[12]

The Guardian recently reported on the little-known long-term sexual dysfunction side effects of antidepressants. When selective serotonin reuptake inhibitor (SSRI) antidepressants were launched in the late 80s, their initial labels stated that fewer than 5% of patients in clinical trials reported sexual dysfunction. However, in some unpublished Phase 1 clinical trials of the drugs, more than 50% of healthy volunteers developed severe sexual problems, which in some cases persisted after treatment stopped.[13] 

Involuntary hospitalizations are estimated to account for about 54% of admissions to U.S. psychiatric inpatient settings.[14]  In some Canadian provinces, about half to 75% of adult psychiatric hospital patients are involuntary.[15] In Australia, 45% of hospitalizations in mental health care were involuntary in acute short-term units during 2021-2022.[16]

The publishing firm, Multi-Disciplinary Digital Publishing Institute (MDPI) reported this month: “These practices raise important human rights issues,” adding: “There is a momentum internationally to move away from using coercive measures in mental health services” in order to “render imposing restrictions unnecessary, thus preempting, preventing and reducing coercion.”[17]

Opposition to this has financial motives, CCHR says. Patients may be held financially liable for the involuntary hospitalization and treatment they did not authorize, want, and even actively refused.[18] The global behavioral health market valued at $52 billion in 2022, is expected to hit $107.3 billion over the next eight years, according to a market analysis.[19]

CCHR provides protective tools on its website. Most parents, it says, are unaware of the Prohibition on Mandatory Medication Amendment which passed into federal law in 2004. This prohibits the coercive practice of schools requiring that a child take a psychiatric drug as a requisite for attending school. A Parent’s Exemption Form Prior to Mental Health and Psychological Screening or Counseling can be downloaded from its website.

Advanced directives are potentially powerful tools in avoiding non-consensual treatment, which CCHR encourages people to sign. Patients and their families can also report abuse to CCHR and take affirmative action to seek recourse for any damage incurred. Knowing your rights to fight psychiatric coercion is vital, it says.

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[1] “Trapped in a psych ward: Michigan doc pre-signed blank forms that can rob you of your freedom,” ABC 7 WXYZ Detroit, 29 Feb. 2024, https://www.wxyz.com/news/local-news/investigations/trapped-in-a-psych-ward-michigan-doc-pre-signed-blank-forms-that-can-rob-you-of-your-freedom

[2] Dainius Pūras, et al., “Reducing coercion in mental healthcare,” Epidemiol Psychiatr Sci., 9 July 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032511/

[3] Lene Lauge Berring, Eugenie Georgaca, “A Call for Transformation: Moving Away from Coercive

Measures in Mental Health Care,” Healthcare, 17 Aug. 2023,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454462/pdf/healthcare-11-02315.pdf

[4] “The ethics of coercion in mental healthcare: the role of structural racism,” Journal of Medical Ethics, BMJ, June 2023, https://jme.bmj.com/content/early/2023/10/16/jme-2023-108984

[5] “Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis,” JAMA Psychiatry, July 2017, https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2629522/

[6] https://www.samhsa.gov/trauma-violence

[7] “Civil Commitment and the Mental Health Care Continuum: Historical Trends and Principles for Law and Practice,” SAMHSA, p. 1

[8] Ibid. p. 5

[9] Psychiatry in 1984 vs. now: Has progress come at a cost? (kevinmd.com)

[10] https://www.cchrint.org/2022/07/11/billions-spent-on-violence-prevention-ignores-how-psychotropic-drugs-cause-hostility/, citing Faith Myers vs. Alaska Psychiatric Institute, Supreme Court, 2-11021, Superior Court No. 3AN-03-00277, Opinion, No. 6021, 30 June 2006, https://caselaw.findlaw.com/ak-supreme-court/1004032.html

[11] Deborah Oyine Aluh, et al., “Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care,” Healthcare, July 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10379438/

[12] https://ps.psychiatryonline.org/doi/10.1176/appi.ps.20220296

[13] David Cox, ‘It feels like we’ve been lobotomised’: the possible sexual consequences of SSRIs,” The Guardian, 2 Mar. 2024, https://www.theguardian.com/society/2024/mar/02/ssri-antidepressants-sexual-dysfunction-side-effects-consequences-libido  

[14] https://www.cchrint.org/2022/06/29/us-could-learn-from-reform-of-coercive-mental-health-practices/, citing “Involuntary Commitments: Billing Patients for Forced Psychiatric Care,” The American Journal of Psychiatry, 1 Dec. 2020, https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030319

[15] https://thewalrus.ca/why-are-so-many-psychiatric-patients-forcibly-detained-and-treated/

[16] https://www.aihw.gov.au/mental-health/topic-areas/involuntary-treatment

[17] “Moving Away from Coercion in Mental Health Care,” Healthcare, Mar. 2024, https://www.mdpi.com/journal/healthcare/special_issues/0CMYC683V7

[18] https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030319

[19] “Behavioral health market to hit $107B by 2032,” Becker’s Behavioral Health, 7 Mar. 2024, https://www.beckersbehavioralhealth.com/behavioral-health-capital-investment/behavioral-health-market-to-hit-107b-by-2032.html?origin=BHE&utm_source=BHE&utm_medium=email&utm_content=newsletter&oly_enc_id=3257B5846812I1X