Patients report physical, psychological, and sexual abuse, neglect, and human rights violations that leave them feeling lonely, humiliated, and powerless.

A new study has brought needed attention to the abuse of psychiatric patients by staff in mental health settings, including in the U.S. mental health system.  The researchers call for stronger legal protections for mental health patients and reforms to mental health systems to ensure services are patient-centered, delivered without coercion, and uphold human rights. 

Noting that studies on patient safety rarely directly address the violence and abuse perpetrated by healthcare professionals, researchers from Kansai Medical University and Japan Centre for Evidence-Based Practice conducted a review of existing medical literature to establish, among various objectives, the nature and rate of occurrence of abuse perpetrated by staff in mental health service settings.

Among 61 published studies and reviews focusing on this abuse, 12 studies reported on the prevalence, though four used the same underlying dataset.  The studies involved data collected from 622 patients, 208 healthcare staff, and public records.  All the studies concerned abuse by staff in inpatient psychiatric facilities.

Participants in the studies “described feelings of physical and psychological threat, dehumanization, being ignored, having their care requests neglected and receiving coercive treatment that was perceived as unethical,” according to the review.  “They also described emotional responses such as loneliness, humiliation, powerlessness and loss of trust in healthcare professionals.”

The researchers grouped the acts of abuse into six categories.  Rather than calculating a single figure for the prevalence of each category of abuse, the researchers presented the range for each category that encompassed the ranges from all included studies.

• Physical abuse, which included excessive physical force and assault, was reported by a range of 5%-65% of participants in the studies. 

• Psychological abuse, including verbal insults and threats, was reported by 0%-79%. 

• Sexual abuse, reported by 0%-21%, included unwanted sexual contact or advances. 

• Economic abuse, such as theft or unauthorized use of patients’ property by staff, was reported by 15%-36%. 

• Neglect, meaning lack of access to basic care, such as meals, was reported by 0%-79%. 

• Human rights violations from dehumanizing treatment, such as being subjected to hours in restraints or seclusion, or being forced to undress in view of others, were reported by 5%-61% of participants.

“Our findings suggest that preventing abuse in psychiatric settings requires both attention to individual attitudes and behaviors, and structural and cultural changes within healthcare institutions,” the researchers concluded.  Their review was published in BMJ Open.

They also noted that a trend of increased attention to the issue of abuse by psychiatric facility staff “may reflect growing professional and societal concern about coercive practices in psychiatric care.”

Coercive psychiatric practices include involuntary hospitalization, forced psychiatric drugging, involuntary electroconvulsive therapy (ECT), seclusion, and physical, chemical and mechanical restraint.

Since 1969, the Citizens Commission on Human Rights (CCHR) has been a global leader in the fight to eliminate coercive and abusive psychiatric practices and expose the harm and fraud in involuntary psychiatric detention and treatment. 

International human rights standards now call for ending coercive psychiatric practices and replacing them with human rights-based approaches to mental health.  This position is backed up by research, such as a 2023 study indicating no benefit to patients’ mental health condition and no reduction in their risk of suicide after receiving nonconsensual mental health treatment. 

The issue of coercive practices was prominently addressed in 2021 by the World Health Organization (WHO) and in 2023 in guidance published jointly by WHO and the United Nations Office of the High Commissioner for Human Rights, calling on governments to adopt “zero coercion” policies. 

“People subjected to coercive practices report feelings of dehumanization, disempowerment, being disrespected and disengaged from decisions on issues affecting them,” according to the WHO.  “Many experience it as a form of trauma or re-traumatization leading to a worsening of their condition and increased experiences of distress.”

In 2022, Europe’s leading human rights assembly, the Parliamentary Assembly of the Council of Europe, urged the Council’s 46 member states to take action against forced institutionalization.  The Council underscored this commitment last month by rejecting a draft protocol for mental health settings that would have expanded involuntary psychiatric detention and treatment across Europe, making it “more difficult to abolish coercive practices in mental health services,” according to the Council.

Although the European Psychiatric Association indicated in 2024 that a reduction of coercive practices in psychiatry was a priority, it instead supported the draft protocol that would have further entrenched involuntary psychiatric detention and treatment, which the Council of Europe rejected.

The World Psychiatric Association (WPA), while not renouncing coercive practices, ratified a position statement in 2023 that called for implementing alternatives to coercion in psychiatric practices.  The WPA admitted, “There is widespread agreement that coercive practices are over-used” in psychiatry.

The American Psychiatric Association (APA) has thus far refused to issue a position statement aligned with international human rights standards.  In its most recent (2020) “Position Statement on Voluntary and Involuntary Hospitalization of Adults with Mental Illness,” the APA continues to support the use of coercive practices.

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