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, warning that institutional psychiatric treatment can separate people from their communities, limit autonomy, and expose them to human rights violations. The guide notes that 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 significance of this announcement lies in its challenge to the prevailing U.S. mental health system, which annually subjects more than 1.2 million Americans to involuntary commitment—about two every minute. A Harvard School of Public Health study cited by CCHR 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 (UNCAT), which the U.S. has ratified. The WHO guidance provides a roadmap for reform, but the U.S. is moving in the opposite direction, with legislative reforms often becoming procedural formalities that legitimize restrictive interventions under the guise of legal protection, according to the American Bar Association. A 2021 national study found wide variation in involuntary psychiatric detention rates across 25 states, from 29 per 100,000 in Connecticut to 966 per 100,000 in Florida—a 33-fold difference—with most states recording 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, grounded in international human rights law, including the UN Convention on the Rights of Persons with Disabilities. Key points include that psychiatric hospitals continue to dominate mental health systems in many countries, often marked by excessive rules and widespread coercive measures such as forced medication, mechanical restraint, and seclusion. The guidance calls on governments to review and revise involuntary commitment criteria to align with human rights standards, promote rights-based approaches that protect against coercion, 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. The WHO guide itself is available at https://www.who.int/publications/i/item/9789240124134/, and further research on the consequences of involuntary hospitalization can be found in a Federal Reserve Bank of New York staff report at https://www.newyorkfed.org/medialibrary/media/research/staff_reports/sr1158.pdf?sc_lang=en/. Legal analysis of when mental health coercion constitutes torture is discussed in a Fordham International Law Journal article at https://ir.lawnet.fordham.edu/ilj/vol45/iss5/2/. The American Bar Association's recent report on the human rights crisis in authoritarian times is available at https://www.americanbar.org/groups/crsj/resources/human-rights/2025-july/human-rights-crisis-authoritarian-times/.
