World Health Organization’s Latest Guidance on Mental Health Further Condemns Coercive Psychiatry. CCHR Demands U.S. and Global Psychiatry to Eliminate Forced Detainment and Treatment
By Jan Eastgate
President, CCHR International
April 25, 2025
The World Health Organization’s (WHO) new Guidance on Mental Health Policy and Strategic Action Plans delivers a stark challenge to the psychiatric industry: end all coercive practices. Described as marking a transformational departure from institutionalization and forced treatment, the document demands a rights-based model of care grounded in informed consent and accountability. CCHR welcomes the guidance but noted that the American Psychiatric Association (APA) continues to ignore these global human rights mandates, thereby placing patients at continued risk.
The Guidance builds on prior United Nations Human Rights Council resolutions calling for the elimination of coercion, violence, and institutionalization, affirming that such practices violate international law. (MODULE 1, Page 3)
Among its key principles:
- Prohibit involuntary psychiatric practices (MODULE 1, Page 3)
- Abolish coercive practices, including involuntary hospitalization and treatment (MODULE 1, Page 4)
- Replace coercive, forced drugging, electroshock, and psychosurgery with informed consent-based approaches (MODULE 1, Pages 3–4)
- Guarantee the right to refuse treatment (MODULE 1, Page 4)
- Enforce legal capacity that cannot be removed or substituted (MODULE 1, Page 3)
- Respect advance directives allowing people to determine their care in crisis, including the right to refuse all treatment (MODULE 1, Page 4)
The guidance calls for transparent and accountable monitoring frameworks and to hold services accountable: For example:
- Data should be collected and maintained on: the number of voluntary and involuntary admissions, with length of stay; number of patients subjected to physical, mechanical or chemical restraints; deaths in psychiatric institutions, including mortality rates associated with treatments and interventions; psychotropic drug usage, and violations of advance directives. (MODULE 2, Pages 16–17)
CCHR underscores the importance of this. Yet, in the U.S., such data is rarely publicly available. There is no centralized database tracking patient outcomes in psychiatric institutions.[1]
A rare exception came from a USA TODAY Network investigation in 2024 that 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.[2]
But this data reflects only one aspect of coercion. Research shows 54% of psychiatric admissions in the U.S. have been involuntary.[3] One study found that on a single day—April 30, 2018—57% of inpatient admissions were involuntary, with 89% of public hospital patients admitted against their will.[4]
During hospitalization, patients have reported high levels of abuse:
- 31% experience physical assault
- 8% report sexual assault
- A majority witness traumatic events.
The use of coercive practices, particularly in inpatient environments where many are held on an involuntary basis, is recognized to cause long-standing trauma.[5]
The WHO Guidance recommends the systematic closure of psychiatric institutions in favor of community-based, rights-driven care systems held accountable to the public (MODULE 2, Page 12).
WHO also advocates eliminating financial incentives that support institutional care (MODULE 2, Page 12)—a recommendation CCHR strongly supports. A 2025 San Francisco Chronicle series revealed rampant abuse at 21 for-profit psychiatric hospitals across California. Over six years, these facilities reported hundreds of patient assaults and at least 17 preventable deaths due to gross neglect.[6]
At Signature Healthcare-owned psychiatric hospitals, 11 patients died from substandard care—two-thirds of all for-profit psychiatric hospital deaths cited by the California Department of Public Health (CDPH). One victim, a 20-year-old woman, fatally overdosed on medication prescribed at the facility. A 15-year-old boy asphyxiated himself while under the watch of an unqualified staffer—previously fired for failing to monitor another critically ill child.[7]
At Acadia Healthcare’s Pacific Grove Hospital, a patient reported a staff member kneeling on his neck, cutting off his airway. A social worker warned staff that carrying a patient face-down by arms and legs risked breaking their spine. Universal Health Services (UHS) facilities were also implicated.[8]
In 2024, a jury awarded $180 million in damages–reduced against UHS’s Pavilion Behavioral Health Center in Illinois over the rape of a 13-year-old patient.[9] In 2023, a $480 million judgment was levied against Acadia Healthcare after an 8-year-old girl was repeatedly sexually abused within its foster-care psychiatric system in New Mexico.[10]
The WHO also sharply rejects the biomedical model that portrays mental distress as a neurobiological disease, relying on drug-based interventions. (MODULE 2, Page xii) Instead, it demands:
- Elimination of forced drugging and community treatment orders, which lack supporting evidence and violate rights (MODULE 2, Page 46)
- Ensuring the right to refuse drug or electroshock treatments (MODULE 2, Page 49)
- Supporting informed withdrawal from psychotropics, with full disclosure of side effects and safe discontinuation guidance (MODULE 4, Page 20)
- Prioritizing non-drug, non-coercive first-line interventions (MODULE 2, Page 14)
- Redirecting research funding away from pharmaceutical models and toward service-user-led, rights-based models (MODULE 2, Page 19)
- Research must shift away from pharmaceutical and neuroscientific dominance toward evaluating rights-based models of care and service user-led recovery practices (MODULE 2, Page 19)
CCHR urges federal and state policymakers—and all national and state psychiatric associations—to adopt the WHO Guidance as a national standard. But this is not simply a matter of reform—it is a matter of justice. Since at least 2013, the United Nations and WHO have issued three major global guidelines demanding an end to coercive psychiatric practices. These calls have included the UN Special Rapporteur reports (2013, 2017), the 2021 WHO “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” the October 2023 WHO and the UN Office of the High Commissioner for Human Rights (OHCHR) guidance on Mental Health, Human Rights, and Legislation; UN High Commissioner for Human Rights report on Mental Health and Human Rights, and this year’s WHO Strategic Action Plan.
Despite this, the APA and U.S. psychiatric institutions have systematically ignored these mandates—permitting widespread abuse, silencing victims, and protecting profit-driven systems over patient rights.
This failure is not passive—it is institutional complicity. When international human rights bodies repeatedly call for the abolition of coercive practices, and those warnings are disregarded—especially amid mounting evidence of preventable deaths, rape, assault, and trauma—there must be legal and financial consequences. U.S. legislators must now act to hold psychiatric institutions accountable, defund those that violate human rights, and impose strong penalties on any facility or professional that fails to uphold the most basic protections of dignity, bodily autonomy, and informed consent.
To quote and support CCHR’s co-founder, Prof. Thomas Szasz: “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.”
References:
[1] Soumya Karlamangla, “Their kids died on the psych ward. They were far from alone, a Times investigation found,” Los Angeles Times, 1 Dec. 2019, https://www.latimes.com/california/story/2019-12-01/psychiatric-hospital-deaths-california
[2] David Robinson, “Why did 14K people die with ties to hospital restraints amid pandemic?” Democrat & Chronicle, New York State team, 17 July 2024,
https://www.democratandchronicle.com/story/news/2024/07/17/why-did-14k-people-die-with-ties-to-hospital-restraints-amid-pandemic/73602950007/
[3] Morris, N., “Involuntary Commitments: Billing Patients for Forced Psychiatric Care,” Am J Psychiatry, 1 Dec 2020, https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030319
[5] “Fear, Neglect, Coercion, and Dehumanization: Is Inpatient Psychiatric Trauma Contributing to a Public Health Crisis?” Journal of Patient Experience, 9 Aug. 2022, https://journals.sagepub.com/doi/full/10.1177/23743735221079138
[6] Cynthia Dizikes and Joaquin Palomino, “California is embracing psychiatric hospitals again. Behind locked doors, a profit-driven system is destroying lives,” San Francisco Chronicle, 5 Mar. 2025, https://www.sfchronicle.com/projects/2025/california-psychiatric-hospitals-crisis/
[7] Cynthia Dizikes and Joaquin Palomino, “California is embracing psychiatric hospitals again. Behind locked doors, a profit-driven system is destroying lives,” San Francisco Chronicle, 5 Mar. 2025, https://www.sfchronicle.com/projects/2025/california-psychiatric-hospitals-crisis/
[8] Cynthia Dizikes and Joaquin Palomino, “California is embracing psychiatric hospitals again. Behind locked doors, a profit-driven system is destroying lives,” San Francisco Chronicle, 5 Mar. 2025, https://www.sfchronicle.com/projects/2025/california-psychiatric-hospitals-crisis/
[9] “Illinois Jury Awards $535M: Sexual Assault at UHS Psychiatric Facility,” The Simon Law Firm P.C., 4 Apr. 2024, https://simonlawpc.com/results/illinois-jury-awards-535m-sexual-assault-at-uhs-psychiatric-facility/
[10] https://www.cchrint.org/2023/07/18/for-profit-psychiatric-hospitals-need-stronger-penalties/; Colleen Heild and Olivier Uytterbrouck, “Foster child sexual assault results in $485 million jury award,” Albuquerque Journal, 11 July 2023, https://www.abqjournal.com/news/foster-child-sexual-assault-results-in-485-million-jury-award/article_bfdf6e86-1f70-11ee-b4e3-c7c608def4fe.html
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