The World Health Organization has issued 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 individuals from their communities, limit autonomy, and expose them to human rights violations. According to the guidance, nearly half of people 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 organization points to stark figures: more than 1.2 million Americans are involuntarily committed to psychiatric facilities each year—roughly two every minute. 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. Most of the 22 states with six or more years of data recorded increases over time, consistent with international trends.
CCHR also cites a Harvard School of Public Health study indicating 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, which the U.S. has ratified. 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.”
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 United Nations Convention on the Rights of Persons with Disabilities. It notes 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 recommends that hospitals assess quality and human rights conditions, including safeguards relating to coercion, seclusion, restraint, or violence, and reduce institutional practices while ending violations such as electroconvulsive therapy without anesthesia. It cites Argentina’s Río Negro province, which enacted a law oriented toward community-based care and explicitly rejected electroconvulsive therapy.
Furthermore, the WHO advises 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. The full guidance is available at https://www.who.int/publications/i/item/9789240124134/.
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 organization, a nonprofit mental health watchdog established in 1969 by the Church of Scientology and Thomas Szasz, investigates and exposes psychiatric human rights abuses and has secured hundreds of laws internationally protecting those rights.
For those seeking further information, the New York Fed staff report on involuntary hospitalization is available at https://www.newyorkfed.org/medialibrary/media/research/staff_reports/sr1158.pdf?sc_lang=en/, and a Fordham International Law Journal article on when mental health coercion constitutes torture can be found at https://ir.lawnet.fordham.edu/ilj/vol45/iss5/2/. The American Bar Association’s analysis of involuntary mental health treatment as a human rights crisis is at https://www.americanbar.org/groups/crsj/resources/human-rights/2025-july/human-rights-crisis-authoritarian-times/.
