The World Health Organization 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 report notes that nearly half of individuals 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 urging U.S. state mental health departments to adopt the WHO policy and lead the world toward rights-based systems.
The scale of coercive practices in the United States is staggering. More than 1.2 million Americans are involuntarily committed to psychiatric facilities each year—roughly two every minute. A Harvard School of Public Health study found 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, which the U.S. has ratified. CCHR president Jan Eastgate criticized the status quo: “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.”
Despite international momentum toward reform, 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 legislative reforms often become procedural formalities that legitimize restrictive interventions. 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 showing increases over time.
The WHO guidance emphasizes that deinstitutionalization is essential to building a rights-based mental health system. It calls on governments to review and revise involuntary commitment criteria, promote alternatives to coercion, provide access to legal advocacy, and implement policies to prevent restraint, seclusion, and violence. The guidance also highlights successful models, such as Argentina’s Río Negro province, which enacted a law oriented toward community-based care and explicitly rejected electroconvulsive therapy.
CCHR is calling on 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, states can reverse the trend toward greater coercion, restore autonomy and dignity, and set a global example of rights-based mental health systems. As a watchdog organization established in 1969 by the Church of Scientology and Professor Thomas Szasz, CCHR has secured hundreds of laws internationally protecting mental health rights.
The WHO report’s findings are backed by extensive research, including a New York Federal Reserve staff report on the health and criminal consequences of involuntary hospitalization, available at https://www.newyorkfed.org/medialibrary/media/research/staff_reports/sr1158.pdf?sc_lang=en/, and a Fordham International Law Journal article examining when mental health coercion constitutes torture, at https://ir.lawnet.fordham.edu/ilj/vol45/iss5/2/. The full WHO guide is accessible at https://www.who.int/publications/i/item/9789240124134/, providing a roadmap for countries to transition to community-based care that respects human rights.
