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, which warns that institutional psychiatric treatment can separate people from their communities, limit autonomy, and expose them to human rights violations. According to the WHO, nearly half of people living in large psychiatric hospitals and social care institutions are held against their will for months, years, or even decades. The guide calls for a shift toward community-based care grounded in international human rights law, including the United Nations Convention on the Rights of Persons with Disabilities.
In response, Citizens Commission on Human Rights International (CCHR) is calling on U.S. state mental health departments to adopt the WHO policy and lead the world toward human rights-based systems. CCHR, a nonprofit mental health watchdog established in 1969 by the Church of Scientology and Thomas Szasz, has long investigated and exposed psychiatric human rights abuses. The organization points to the more than 1.2 million Americans involuntarily committed to psychiatric facilities each year—about two every minute—as evidence that current U.S. practices are out of step with international human rights standards.
The WHO guidance highlights that psychiatric hospitals continue to dominate mental health systems in many countries, often marked by excessive rules such as bans on personal belongings, restrictions on movement, and tightly controlled visits. It also documents widespread coercive measures, including forced medication, mechanical restraint, and seclusion. The guide recommends that hospitals assess quality and human rights conditions, including safeguards relating to coercion, seclusion, restraint, or violence, and reduce institutional practices while ending human rights 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, as a positive example.
Despite growing recognition that coercive psychiatric detention and treatment harm autonomy and human rights, 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. In a 2025 analysis, the ABA noted 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." That assessment is available at https://www.americanbar.org/groups/crsj/resources/human-rights/2025-july/human-rights-crisis-authoritarian-times/.
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. Consistent with international trends, most of the 22 states with six or more years of data recorded increases over time. These findings are detailed 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/.
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 guide urges 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 is urging 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 full WHO guidance is available at https://www.who.int/publications/i/item/9789240124134/.
