Human Rights Laws Needed to End Coercive Psychiatric Practices Against African Americans

Indeed, in 2021, the World Health Organization “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” condemned coercive psychiatric practices, that are used, “despite the lack of evidence that they offer any benefits and the significant evidence that they lead to physical and psychological harm and even death.” [1]

Americans take considerable pride in their Constitutionally guaranteed civil liberties, yet mental health laws often abridge or ignore those rights when it comes to certain classes of people—anyone labeled as “mentally ill.” Add to that black, indigenous and people of color (BIPOC). An article published by the American Bar Association says: “Often, there is no clear line of demarcation between mental health care and incarceration. When race and poverty are added to the equation, matters are exacerbated.” [2]

African Americans and people of color are overrepresented in this coercive psychiatric system:

• Involuntary hospitalizations are estimated to account for about 54% of admissions to U.S. psychiatric inpatient settings. [3]
• The “Report on forced psychiatry and psychiatric abuse against African Americans,” jointly prepared by some nine disability rights groups, said the violence inflicted on African Americans by public mental health systems needs to be condemned. “Forced medication in particular is an act of disability-based violence that can amount to ill-treatment or torture, as is also the suffering inflicted by indefinite detention in the mental health system.”  Further, “The mental health system as a system of social control is intricately linked to racism.” The groups recommended: “The United States should prohibit mental health commitment and forced treatment, so as to end the social control function that has been given to the mental health system, which has a discriminatory impact on people of color.”[4]
• African Americans are over-represented in restraint-related deaths, accounting for 22% of studied deaths while comprising only 13% of the U.S. population.[5]
• Andreu Gibson, a behavioral technician based in North Carolina, tells us: “Black people, Black minds, Black bodies have been used as scientific experiments, and the echoes of that remain. It’s not just echoes and shadows — it still happens to this very day, just in different ways.” Gibson explained racial bias can begin with the intake process with “the age-old notion of ‘Black people are less than,’ ‘Black people are subhuman,’ ‘Black people are incapable of control.’” These are damaging narratives that uphold bias in healthcare settings. [6]
• Black men are over-diagnosed with “schizophrenia” (four times more likely than white men), which prior to the civil rights movement was considered  “a largely white, docile and generally harmless condition” but then research articles asserted that the “disorder” manifested by rage, volatility and aggression afflicting “Negro men,” as reported in a 2020 article in Counseling Today. Researchers conflated the symptoms of black individuals with perceived schizophrenia of civil rights protests, labeling them with “protest psychosis.” Authors of an article Archives of General Psychiatry in 1968 wrote that psychiatric treatment was required because symptoms threatened black men’s own sanity as well as the social order of white America.” Antipsychotics—which can cause psychosis—were the proffered treatment.[7]
• Young black students are disproportionately prescribed psychotropic drugs at an alarming rate.[8]

A further threat to this is that in the wake of acts of mass shootings, psychiatrists are urging governments to broaden the criteria for involuntarily committing someone—misleadingly implying this could protect the community from future “dangerous behavior.” However, the evidence doesn’t support this and on the contrary, shows that psychiatric “treatment” causes aggressive, violent and suicidal behavior. Twenty-seven drug regulatory agency warnings link psychiatric drugs to violent and homicidal side effects. With such adverse reactions, forcing more of these mind-altering chemicals on individuals and through longer periods of involuntarily commitment is a recipe for disaster. [9]

The need to abolish coercive psychiatric practices is entrenched in international human rights covenants and reports. In April 2022,  the United Nations High Commissioner for Rights report said that coercion, involuntary treatment and forced placement are incompatible with human rights.  A similar UN Human Rights Council report in 2018 said laws should be repealed that permit the use of coercion and forced interventions, including the use of restraints, electroshock, psychosurgery, and forced medication.[10]

While the U.S. is a signatory to the UN Convention on the Rights of Persons with Disabilities (CRPD), it has not ratified it so it is not entrenched in domestic or federal law, while it maintains its Americans with Disabilities Act (ADA) enacted in 1990 and, which inspired the CPRD. [11] However, the ADA does not go far enough to end coercive psychiatric practices.

Human rights abuses are so pervasive in the field of mental health in the U.S. that mental health laws must change to eliminate coercive psychiatric practices, instill human rights in their place and reverse the systemic failure and abuses in the system.  

Memorandum:

The following UN and WHO reports are guidelines to make changes in U.S. mental health law federally and in every state.

The February-April, 2022 Annual Report of the UN High Commissioner for Human Rights, which reinforced similar reports in 2017 and 2018, primarily recommended:  

• Provisions on forced mental health institutionalization and treatment should be repealed to be replaced with rights-based and decision-making mental health services in the community.
• There is an overreliance on mental health drugs, which are a “significant obstacle to the realization of the right to health.”
• The focus of mental health systems and services should be widened beyond the biomedical model to include a holistic approach that considers all aspects of a person’s life. [12]
• The Commissioner’s 2018 report said that “legal provisions and policies permitting the use of coercion and forced interventions, including involuntary hospitalization and institutionalization, the use of restraints, psychosurgery, forced medication, and other forced measures” should be repealed. “States should reframe and recognize these practices as constituting torture or other cruel, inhuman or degrading treatment or punishment. [13]

Other supportive reports that policymakers should be aware of and adopt, include:

• In a joint statement issued in May 2021, the UN CRPD Committee, two UN Special Rapporteurs, and an array of experts said the “growing consensus” within the UN and WHO that the coercive approach to mental health is “doing harm” and forced admission and treatments in institutions brings “harmful effects such as pain, trauma, humiliation [and] shame.” [14]
• The WHO Guidelines noted that countries must ensure that “informed consent” is in place and that “the right to refuse admission and treatment is also respected.” Also, “People wishing to come off psychotropic drugs should be actively supported to do so” (with resources to achieve this).” [15]
• In June 2021, Dr. Danius Pūras, a psychiatrist and former UN Special Rapporteur on a Right to Health while conceded there were “serious arguments of professionals who warn against a prohibition of forced treatment. They insist on retaining legal permission to treat individuals with serious mental health conditions involuntarily in exceptional circumstances….However, these good intentions are failing.” Further, “Let us assume that each case of using nonconsensual measures is a sign of systemic failure.” [Emphasis added] He also pointed out that accountability for serious harms is important so that the harms are not repeated.” [16]
• This reinforced his comments in 2019 when he advised adopting strategies with a rights-based approach that avoided excessive medicalization. [17]
• In November 2020, the CRPD reported that the use of forced treatment, seclusion and various methods of restraint should be prohibited as torture and other cruel, inhuman or degrading treatment or punishment of persons with disabilities. [18]
• In 2013, the UN Special Rapporteur on Torture called for a ban on forced treatment such as psychosurgery, electroshock and mind-altering drugs such as neuroleptics, [and] the use of restraint and solitary confinement, for both long- and short-term application.”[19]

A Mental Health Declaration of Human Rights is a right-based guideline for positive implementation in mental health laws.

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