Citing a new report on the success of no-restraint policies in Italy, Citizens Commission on Human Rights calls for mental health care reforms that align with international standards for a human rights-based approach in mental health practices.
by CCHR National Affairs Office
A new report details the success of an initiative in Italy to safeguard the human rights of psychiatric patients by ending the use of restraints in some of the country’s hospital psychiatric wards. Citizens Commission on Human Rights (CCHR) calls on Congress to take long overdue action towards eliminating restraints, as well as seclusion, forced drugging and other coercive psychiatric practices in the U.S., aligning with international standards to protect and ensure human rights in mental health care.
Italian researchers investigated the results of no-restraint policies in 24 Italian hospital psychiatric units, which had an average of 13 beds per unit. The country’s no-restraint initiative calls for no use of restraints and no locked doors leading into the ward. Restraints are belts or straps used to restrict a person’s movement, typically by strapping them to a bed or table.
Researchers found that 14 of the 24 units reported no use of restraints during 2022, while the other 10 units used restraints an average of just 4.5 times during the year and committed to eliminating the use completely. Two-thirds (63%) of the units operated with no locked access doors to the unit. Patients were allowed to keep personal items such as telephones and computers.
“This research adds empirical weight to the advocacy for restraint-free environments in mental health settings, signaling a paradigm shift toward more humane and rights-respecting” care, the researchers wrote.
In 2023, the World Health Organization (WHO) and the United Nations Office of the High Commissioner for Human Rights called for an end to all forced mental health treatment, saying coercive practices “violate the right to be protected from torture or cruel, inhumane and degrading treatment.”
Earlier guidance from WHO in 2021 stated that coercive mental health treatment should end even for those experiencing acute mental distress, pointing out that individuals in mental health crisis “are at a heightened risk of their human rights being violated, including through forced admissions and treatment,” which “have been shown to be harmful to people’s mental, emotional and physical health, sometimes leading to death.”
Earlier still, the Council of Europe in 2019 adopted a resolution that called on its member nations “to immediately start to transition to the abolition of coercive methods in mental health settings.” The resolution cited evidence pointing to the “overwhelmingly negative experience of coercive measures, including pain, trauma and fear.”
Among international psychiatric organizations, the World Psychiatric Association has stated its concern about “the extent to which coercive interventions violate” human rights, and the European Psychiatric Association has said that examining how to reduce coercive practices in psychiatry is a priority for the association.
In contrast, the American Psychiatric Association has maintained its position in support of involuntary psychiatric practices, despite the traumatic impact the practices can have on patients’ emotional well-being and self-worth.
“It is urgent that Congress investigate the harm from the forced psychiatric treatment of vulnerable Americans experiencing mental health issues,” said Anne Goedeke, president of the CCHR National Affairs Office. “Congress must take the lead on needed reforms in the U.S. mental health system, since the American Psychiatric Association has proven unwilling to change its position on its coercive practices to align with international standards for human rights-based mental health treatment.”