WHO Deinstitutionalization Guide Spurs CCHR Call for Texas Mental Health Reform

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, which warns that institutional psychiatric treatment can separate people from their communities, limit autonomy, and expose them to human rights violations. Nearly half of people living in large psychiatric hospitals and social care institutions are held against their will for months, years, or even decades, according to the WHO. In response, Citizens Commission on Human Rights International (CCHR) is calling on U.S. state mental health departments, including Texas, to adopt the policy and lead toward human rights-based systems.

The stakes are significant: every year, more than 1.2 million Americans are involuntarily committed to psychiatric facilities—about two every minute—according to a 2025 Federal Reserve Bank of New York staff report. A Harvard School of Public Health study cited by CCHR says psychiatric hospitals continue to abuse the incarcerated, using forced electroshock, chemical restraints, and prolonged mechanical restraint—practices violating the United Nations Convention against Torture, which the U.S. has ratified. The WHO guidance, available at https://www.who.int/publications/i/item/9789240124134/, emphasizes that deinstitutionalization is essential to building a rights-based mental health system and calls on governments to review involuntary commitment criteria, promote legal advocacy, and prevent coercion, restraint, seclusion, and violence.

Despite growing recognition that coercive psychiatric detention harms autonomy and human rights, the United States is moving in the opposite direction, according to CCHR. 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 have often become procedural formalities that legitimize restrictive interventions under the guise of legal protection. 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.

The financial implications are substantial. 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.” For Texas, which operates one of the nation’s largest public mental health systems, the WHO guidance and CCHR’s demands raise questions about how state funding is allocated between institutional care and community-based services. Reallocating resources toward community care could reduce costs, improve outcomes, and align with international human rights standards, but it would require legislative action and a shift in provider incentives.

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. As a nonprofit mental health watchdog organization established in 1969 by the Church of Scientology and Thomas Szasz, CCHR investigates and exposes psychiatric human rights abuses and has secured hundreds of laws internationally protecting those rights.