‘Tied Up, Forcibly Medicated’: Human Rights Abuses ‘Far Too Common’ in Mental Health Care

“I was held down, tied up, forcibly medicated and placed in a seclusion cell,” Jarrod Clyne of the International Disability Alliance told the international launch of a guide on mental health and human rights on Monday.

This had happened in New Zealand “on the basis of a diagnosis of bipolar disorder, during a manic episode”, Clyne told the launch of the guide, which has been developed by the World Health Organization (WHO) and the Office of the High Commissioner on Human Rights (OHCHR).

Jarrod Clyn (right) from the International Disability Alliance experienced abuse in a mental institution.

Human rights abuses and coercive practices in mental health care, including involuntary hospitalisation and treatment, are still “far too common”, according to the WHO in a statement.

“An estimated one in eight people globally live with a mental health condition. And yet, most of them lack access to the health services they need. People with mental health conditions often face human rights violations, including stigma and discrimination as well as coercion, abuse or neglect in care,” WHO Director-General Dr Tedros Adhanom Ghebreyessus told the launch, on the eve of World Mental Health Day on Tuesday.

“The guidance we’re launching today serves as a roadmap for countries to develop, implement, and evaluate laws that protect and promote mental health and human rights,” added Tedros. “It can catalyse legislation reform, opening doors to care and services that are person-centred, rights-based and recovery-oriented.”

Volker Turk, UN Human Rights Commissioner

Volker Türk, the United Nations (UN) High Commissioner for Human Rights, said the COVID-19 pandemic had both exacerbated many people’s mental health problems and exposed how mental health laws in every region are often based on “the coercive and institutionalised approach”.

“Our new joint guidance is intended as a long overdue course correct,” said Volker.”Our ambition must be to transform mental health services, not just in their reach, but in their underlying values, so that they are truly responsive to the needs and dignity of the individual, that they are enabling people to participate fully in their own recovery.”

Orientation away from psychiatric hospitals

Devora Kestel, WHO Director of Mental Health and Substance Abuse, pointed out that low and middle-income countries (LMICs) spent over 70% of their mental health budgets on mental hospitals or institutions, while high-income countries spent around 35% of their budgets on institutions.

“Overall, these hospitals account for $2 out of every $3 spent globally by governments on mental health where they should instead be invested in community-based services,” said Kestel.

Devora Kestel, WHO Director of Mental Health and Substance Abuse.

“And we know from many reports that those institutions are associated with extensive abuses. Institutionalisation is an example of one issue that this guidance is tackling by promoting the closure of institutions while supporting the development of alternative community-based health service,” she added.

“Stigma, discrimination, as well as the disempowering messages that many people receive within the mental health system is also a huge challenge to overcome,” added Michelle Funk, WHO’s head of Policy, Law and Human Rights in the Department of Mental Health.

“For example, in many cases, when people receive a diagnosis, they’re often treated as being unable to actively participate and contribute to society, leading to further marginalisation and exclusion,” said Funk.

“Another pressing issue is that services have placed too much emphasis on diagnosis and the use of medication in order to manage symptoms, rather than taking a holistic person-centred, rights-based approach to treatment and care.”

An extract from Michelle Funk’s presentation on the guidance.

The guidance sets out what needs to be done to accelerate deinstitutionalization and establish a rights-based community approach to mental health care. This includes adopting laws to gradually replace psychiatric institutions with “inclusive community support systems and mainstream services, such as income support, housing assistance and peer support networks”.

People with mental conditions taking charge 

Caroline Mazel Carlton, a US mental health activist, has been hearing voices since she was a child and initially took heavy medication to quieten them.

“When I met the biomedical model, I learned that the world was afraid of me. They were afraid of me because people thought I was psychotic and dangerous and that was really lonely,” sais Mazel Carleton.

“The doctors did prescribe a lot of pills, and I think that me being given pills made other people feel better, like less afraid of me. But taking the pills did not solve my problems. Basically, they just slowed my mind and body down. I gained a lot of weight and I also ended up sleeping 16 hours a day.”

And the voices didn’t go away: “My voices sounded like they were underwater; like they were drowning, and it was scary.”

After a number of turbulent years, Mazel Carton quit her medication and now works for Wildflower Alliance, helping those with auditory and visual hallucinations. They have developed a number of coping strategies, including using the voice recording function on mobile phones to help discern whether the voices they hear are internal or external.

Nigerian mental health activist Hauwa Ojeifo.

Nigerian mental health activist Hauwa Ojeifo has been belittled and discounted by psychiatrists treating her for bipolar disorder and post-traumatic stress.

“I’m a person who refused to stay in the shadows of a system that’s riddled with abuse and allows my lived experience to be reduced to nothing,” said Ojeifo. “But guess what, according to how the mental health system works, I have no rights to be anything other than a patient.”

“It has been daunting to be diminished because I am not a health professional. But I do still maintain that no one knows about my condition more than I do.”

Ojeifo has formed an organisation, She Writes Woman, to assist people who have mental health issues.

“I have seen the life-threatening effect of the lack of informed consent and involuntary detention on people with mental health conditions,” Ojeifo told the launch.

“The simple claim that people with mental health conditions have full and equal rights and can be active participants and co-creators in their own mental health journeys is perhaps the most threatening ideology to the biomedical model of mental health,” she added.

“When we are urging a movement beyond the biomedical model, the key word here is ‘beyond’. It’s not leaving medication completely behind; it’s not preaching against medication. It is an attempt to get people to reorient themselves away from the dominance of that model.”

The guidance proposes new approaches, including “person-centred and community-based services” that are developed with “the engagement and participation of those with lived experience, including experience of intergenerational trauma”.

“This collaborative approach is essential to create a mental health system that respects human rights, prioritises care and support over control, and supports individuals in achieving their full potential.”

The launch was also addressed by government officials from Portugal, Brazil, Israel and the Philippines who reported on progress they are making to take a more human rights approach to mental health.

Extract from Funk’s presentation on the guidance.

Image Credits: Joice Kelly/ Unsplash.

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