On March 25, the World Health Organization published a 44-page document, Guidance on Mental Health Policy and Strategic Action Plans, that reflects the ongoing work of global activists who have fought for a paradigm shift in mental health. The publication was WHO’s first comprehensive mental health guidance it has issued in 20 years, and it puts human rights at the center of its call for fundamental changes in global mental health policies.
Within the last 20 years, the advocacy of disabled people and psychiatric survivors led to the adoption of the historic Convention on the Rights of Persons with Disabilities (CRPD) at the United Nations. The guidance also acknowledges that the last decade and a half has seen emerging perspectives that reflect a “shift from a primarily biomedical focus toward approaches that are more person-centered, recovery-oriented, and grounded in human rights.”
WHO launched its new guidance on March 25, with the online event featuring WHO officials, ministers of global health, persons with lived experience, and other experts, many of whom acknowledged the gap between the vision reflected in the new guidance and the on-the-ground realities in many parts of the world.
“Mental health systems are outdated, underfunded, and misaligned with evidence-based practices and human rights standards,” WHO Director-General Tedros Adhanom Ghebreyesus said in his opening remarks. “As a result, many people suffer due to inadequate care, exclusion, and lack of access to the support they need.”
The guidance highlights the discrepancy between many countries’ stated commitments to achieving human rights-based mental health systems, and their widespread failure to implement needed reforms and reallocation of resources. Michelle Funk, head of WHO’s Policy, Law and Human Rights Unit for Mental Health and Substance Use and co-author of the guidance, told the online audience of over 2,000: “Today we stand at a pivotal moment in our journey to transform mental health systems globally. This is not just another event. It’s a call to action.”
A Holistic Approach to Mental Health Reform, Grounded in Social Justice
The WHO guidance is organized into five policy areas in need of urgent change: leadership and governance, service organization, workforce development, person-centered interventions, and addressing the social and structural determinants of mental health. The guidance encompasses a menu of policy directives across these areas that can be tailored to specific contexts, as well as country case scenarios and a comprehensive directory of policies and strategies.
One of the overarching themes in the guidance is “safe, planned deinstitutionalization.” “Rather than simply closing institutions, the guidance provides a roadmap for transitioning to strong community care systems,” Funk said.
The WHO guidance notes that merely shifting to a community-based system of care is insufficient. “Smaller community services can also replicate these violations, acting as mini-institutions,” the document states. The guidance emphasizes that systems and services should focus on “comprehensively eliminating institutional mindsets and practices.”
Another focus is supporting countries to eliminate coercion and abuse through systemic reforms, as well as upholding individuals’ legal capacity and decision-making rights. “This isn’t just aspirational,” Funk emphasized. “The guidance proposes concrete steps to eliminate coercive practices, involuntary treatment, and promote more generally rights-based approaches.”
Strategies include the use of financial incentives such as insurance reimbursements to implement care that avoids coercion.
Funk also underscored the guidance’s emphasis on the meaningful inclusion of people with lived experience in decision-making and policy making, ensuring that “reforms are grounded in real-world needs.”
The guidance outlines recommendations for increasing the representation and participation of directly impacted people, such as drafting collaborative standards, creating financial incentives such as equal compensation for lived experience, developing opportunities for professional development, and establishing leadership positions in training and research.
Further, the new guidance advocates for shifting away from “historic overreliance on the biomedical approach and psychotropic drugs.” Ahmed Hankir, a psychiatrist and expert by lived experience who co-facilitated the discussion, noted that the WHO guidance is not “against” the prescribing of psychiatric drugs per se. “What we are against is the prescribing of powerful psychiatric drugs when it isn’t necessary, and for longer than necessary, and in higher doses than necessary,” he said, reflecting on his own “terrible experience” with metabolic syndrome.
“Our threshold for prescribing psychiatric drugs shouldn’t be so low,” he said. “There’s so much that we can do before we get that prescription pad out.”
The guidance also emphasizes cross-sector collaboration to advance the social determinants of health: “By addressing broader social and structural determinants — such as poverty, housing insecurity, unemployment, and discrimination — and emphasizing multi-sectoral collaboration, the guidance promotes a holistic approach to mental health reform, advancing equity and social justice.”
Each section includes considerations for diverse groups including “children and adolescents, older adults, women, men and gender-diverse persons, the LGBTQI+ community, disabled people, migrants and refugees, persons from minoritized, racial and ethnic groups, Indigenous Peoples, and persons who are houseless or with unstable housing,” noting that “due to unique characteristics, life circumstances, or unmet needs, these groups may require specific support and attention beyond that of the general population.”
Ambitious Goals Meet Grim Global Realities
Jarrod Clyne, deputy executive director of the International Disability Alliance, and who identifies as a person with lived experience, began his remarks at the WHO launch by describing his three months of involuntary confinement in a locked unit 25 years ago: ”I was both physically and chemically restrained … What happened to me was, and remains, common practice. That experience made one thing clear to me: Coercive practices in mental health do not just fail to support recovery. They cause lasting harm.”
Clyne spoke of being “moved to tears” when reading the WHO guidance. “It reflects 20 years of evolution of human rights and policy standards, evidence, and understanding of human diversity,” Clyne said, calling it “the beginning of moral repair, transformed services, and a better future.”
In his remarks, Clyne also highlighted the work of the World Network of Users and Survivors of Psychiatry (WNUSP), underscoring the importance that the WHO guidance places on the meaningful involvement of people with psychosocial disabilities: “Doing so helps us avoid repeating the mistakes of the past.”
In the policy guidance, WHO reiterated its ambitious global target, aiming for 80% of countries to achieve alignment with international human rights standards by 2030.
However, the United States will almost certainly not be among that group of countries. In January, President Trump signed an executive order withdrawing the US from WHO and eliminating US funding for the organization. As the US had been WHO’s largest funder, this withdrawal is likely to cause “enormous strain on the global community” and “significant health consequences for the US,” according to public health experts.
Human rights violations regarding mental health practices in the US have spanned multiple administrations going back decades, but the current administration’s policies bode especially poorly for the change envisioned by WHO. Between Trump’s expressed commitment to send unhoused people to “mental institutions where they belong,” to the shuttering of the Administration for Community Living, to the HHS cuts that have ended vital peer-run programs and services, the era of re-institutionalization is under way.
In the United States, “we are particularly facing a rise in coercive practices with people diagnosed with psychosis, especially those who are homeless,” wrote Leah Georgini, executive director of the International Society for Psychosocial and Social Approaches to Psychosis, US chapter, in the WHO chat. “More and more policies target these individuals and laws are being put into place to force people into involuntary treatment. The social fabric of America’s lack of welfare and support is not addressed. We at ISPS-US uphold this guidance’s demand for rights-based treatment and a focus on social determinants and supports.”
Responses to the WHO Guidance
The launch event concluded with an interactive discussion prompted by questions and issues raised in the chat, which overflowed with people from around the world sharing about their research, their programs, their concerns, and their priorities for the future of global mental health.
One of the first topics of discussion facilitated by Hankir examined the role of psychiatry in human rights abuses. “There needs to be more accountability. And we need to apologize unreservedly,” he said, referencing the 2021 American Psychiatric Association’s apology for its role in supporting structural racism in psychiatric services.
Some attendees also expressed discomfort with guidance’s inclusion of the concept of “stigma” and promotion of anti-stigma campaigns, which have long been criticized for increasing what they set out to reduce, and are not well-supported by evidence. Hankir concurred with attendees, adding: “I would even say that ‘discrimination’ is a euphemism. I think people are being brutalized and dehumanized.”
Many participants, including Archie Lawrence Geneta, psychologist and faculty member with the Department of Behavioral Sciences at the University of the Philippines in Manila, expressed appreciation in the chat for WHO’s move away from the biomedical model to focus on social determinants and social justice. “In the Philippines, where poverty, discrimination, and all forms of abuse are all still prevalent, it is long overdue to have a more dedicated policy and action plan to address mental health fallouts and the intersectionalities associated with these,” Geneta wrote.
Other participants advocated for the WHO to center culturally-grounded and decolonized approaches to mental health, as well as the meaningful inclusion of long-marginalized service-user perspectives. “We need to consider culture…and its connection to mental health,” wrote mental health and child protection specialist Sara Amhaz. “A big component of decolonizing mental health and psychosocial supports is related to considering local, cultural, and traditional mental health and psychosocial support considerations…” noting an ongoing perception that these services are “still using Westernized approaches.”
Olivia Shaw-Lovell, a gender equality advocate and global health consultant who leads Men and Women of Destiny, which is an NGO based in Jamaica and Trinidad and Tobago that provides holistic support focused on survivors of abuse, told of her research focusing on decolonizing global mental health for Black Caribbean women who are survivors of gender-based violence. “Given this, I hope this policy is deeply informed by the narratives and lived experiences of those who will be accessing these services,” Shaw-Lovell wrote.
Still others noted fundamental human rights in their countries and societies. Jim E. Warne, a member of the Oglala Lakota (Sioux) Nation who serves as community engagement and diversity director at University of South Dakota’s Center for Disabilities Oyáte Circle, appealed to WHO and the global community to aid Indigenous Americans. “We have always been underfunded, and the health, disability, and mortality rates remain the worst in the U.S.,” he wrote. “Can WHO help our Indigenous People that are often forgotten or ignored in the U.S.? My reservation has the lowest life expectancy and [highest] youth suicide. We need help from other countries that value Indigenous People.”
One attendee’s question in the chat put into focus the contrast between the vision in the guidance and stark global realities of rising war and inequality: “How can we implement guidance on mental health policy and strategic action plans in countries like Sudan, where basic human rights are lacking?”
A Time for Global Solidarity
Belén González, Spain’s mental health commissioner, spoke plainly to current global realities at the global launch event: “Right now, when it’s becoming harder to defend autonomy, human rights, equality, and equity, and when some forces try to undo what many of us have fought for, having a strong and clear document like this one is more important than ever.”
“In our field, rights must come first,” she added. “Evidence alone cannot protect people from coercion or poor practices. I see this guidance not only as a tool, but as a moral compass. It will help us defend the changes that really matter.”
The hopeful WHO guidance emerges at a time of polycrisis, intersecting global calamities that are unlikely to be solved exclusively at the level of the state. Defending human rights under attack in the US and so many parts of the world will also require grassroots organizing, global solidarity, and mutual aid, according to activists.
Human rights activist Myra Kovary, who participated in the negotiations of the text of the CRPD, wrote: “Greetings from the USA where forced psychiatry is on the rise. After 45 years of activism to stop such human rights abominations, I am heartened by this new and long overdue WHO guidance on mental health policy. Implementation of human rights within the development of any mental health policies will require ongoing vigilance and participation from those of us who have lived experience. Thank you to all who are responsible for this significant step forward, especially for the persons with lived experience who have been bravely speaking out about human rights abominations in so-called mental health ‘treatment’ for decades. ‘Nothing about us without us!’”
And while the guidance recognizes the significant contributions of lived experience to advances in international human rights in mental health, for too long movements of directly-impacted people have been siloed from one another. In his concluding remarks, Michael Njenga, executive council member at the African Disability Forum, and an expert by lived experience from Kenya who significantly contributed to the development of the CRPD, discussed the importance of ongoing cross-movement building: “We keep on talking amongst ourselves … It’s good to think about how to build coalitions with other movements.”
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