The New WHO and UN Guidance: Psychiatry Must Entirely Change

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After years of work involving hundreds of people in dozens of countries, the World Health Organisation (WHO) and the United Nations Office of the High Commissioner for Human Rights (OHCHR) have released their joint production, Mental Health, Human Rights and Legislation: Guidance and Practice (WHO/OHCHR, 2023, referred to as the Guidance. The agenda of the launch event is here, and the full video here).

This outlines in considerable detail the current international legislative framework with which mental health acts in signatory nations need to comply, and provides examples to show how each element of the law can be implemented and tested.

United Nations logo in UN headquarters in Manhattan New York CityAt present, the foundation for international law is the Convention on the Rights of Persons with Disabilities (CRPD, 2006), of which Australia is a signatory. A full list appears in Box 9, p124, along with the four HRC resolutions and three special rapporteurs whose responsibilities cover the field of mental disorder. In one sentence, the CRPD states that no person shall suffer any form of discrimination, loss of liberties or infringement of rights by virtue of a disability, including mental disorders. There is no wriggle room in this.

Chapter 1 of the Guidance, “Rethinking Legislation on Mental Health,” defines mental health, locating its preconditions in the individual’s physical and social environment. In practice, however, this broad definition attracts little more than lip service. Around the world, mental health gets about 2.1% of government health spending, the majority of which is spent on institutions and on physical care: “…the biomedical model, which focuses predominantly on diagnosis, medication and symptom reduction, prevails across existing mental health systems. As a result, social determinants that impact people‚Äôs mental health are often disregarded …” (Guidance, p. 10).

In introducing the launch, the MC listed what he called three major mistakes that current national laws make regarding mental health: the emphasis on detention and involuntary treatment; the over-reliance on the biomedical model; and the failure to involve people with mental disorders in deciding their management. They are “mistakes” because each one is explicitly prohibited by the CRPD or betrays a serious misunderstanding of the nature of mental disorder. Thus, as these features more or less define modern psychiatric practice, it is clear the international human rights community and institutional psychiatry are on collision course.

S4. of the Introduction asks: “Why is the Guidance important?” and looks at a number of reasons, reaching some fairly blistering conclusions:

    1. “A fundamental shift is required within the field of mental health … There is an overreliance on biomedical approaches to treatment options, inpatient services and care, and little attention given to social determinants and community-based, person-centred interventions…”
    2. “Most legislation on mental health fails to embrace a rights-based approach. Many people … are not treated equally before and under the law, and are often discriminated against … legislation may be paternalistic … (People) are routinely deemed incapable of making decisions… no adequate mechanisms to prevent, detect, or remedy these and other human rights violations” (i.e. standard mental hospital procedures unavoidably violate human rights).

    1. “The international human rights framework requires a transformation in the way mental health services are provided. All persons should be able to exercise their right to give free and informed consent to accept or reject treatment in mental health systems. Denial of legal capacity, coercive practices and institutionalization must end.”
    2. “Legislation can … foster a cultural shift that promotes social transformation in the realm of mental health … away from a narrow emphasis on biomedical approaches towards a more holistic and inclusive understanding of mental health …”

In other words, psychiatry has got it all wrong. How wrong? With the entirely benevolent aim of publicising this important document, I emailed the editors of Australian and New Zealand Journal of Psychiatry to see if they would accept a paper on the Guidelines as a “Viewpoint.” According to their website, “Viewpoint articles are longer pieces (3000 words) that allow for personal perspectives and opinions on issues relevant to psychiatry practice and research. They will offer novel insights, show academic rigour, and be of interest to the journal‚Äôs readership. Authorship: At invitation of Editor (who can be contacted with an article proposal).” Forty-five minutes later, back came their answer: No thanks. That’s fine, you don’t believe you’re doing anything out of place. But back to the Guidance.

Chapter 1 describes the state of mental health legislation and gives the relevant international agreements pertaining to health and disability. It starts with the definition: “Mental health is a state of physical, mental, emotional and social well-being, determined by the interaction of the individual with society…” Already, Chapter 1 page 1, we see the sides shaping up for a cosmic brawl. Is mental disorder a genetic disturbance of brain function, or is it not? You can’t have it both ways although, with their spurious biopsychosocial model¬†and their eclectic psychiatry, they tried. The Guidance continues:

The different ways of being, thinking, sensing, expressing, and making sense of the world are part of human diversity: there is no ‚Äúnormal‚ÄĚ or ‚Äúright‚ÄĚ way to be. A failure to understand and respect these differences can lead to isolation and discrimination (p. 9).

This is a direct challenge to psychiatry’s insatiable drive to medicalise the slightest deviation from “normal,” e.g. the relentless drive to diagnose ADHD. They then take up the issue of coercion and loss of freedom of choice, which are part of the fabric of psychiatry: “… mental health laws continue to assume the underlying correctness of coercive practices, which are deemed to be a legitimate form of ‘patient management’ …” (p. 12). Solitary confinement, restraint and shackling are mentioned, in particular with respect to minority and marginalised subcommunities who “…are often denied the few protections mental health legislation may provide for.” Box 2, p. 15, sets out “The case against coercion.”

Box 3, p. 19, lists “CRPD provisions for a rights-based approach to mental health,” including Legal capacity, Liberty and security of person, Free and informed consent, Living independently, Inclusion in the community, and Access to justice. Manifestly, these rights, established by treaty, are routinely breached by psychiatry. In fact, current psychiatric practice is the polar opposite of these principles.

All of these sins are laid before the plinth of what they call the “biomedical model,” which, for years, I’ve been saying doesn’t exist.¬† It’s defined in the Glossary, p. xiii:

The biomedical model of mental health is based on the concept of mental health conditions being caused by neurobiological factors. As a result, care often focuses on diagnosis, medication, and symptom reduction, rather than considering the full range of social and environmental factors (and) may not address the root causes of distress and trauma.

Despite its central role as the fount of all things bad in psychiatry, there is only one reference to this fabled entity, to a paper by Brett Deacon from 2013. Quickly, I found my copy and rechecked it in case I’d missed something: No, I was right. There is nothing in that paper that says such a model actually exists. It remains the case that no psychiatrist, or neuroscientist, or philosopher, or psychologist, has ever written anything that would amount to a reductionist model of mental disorder. Sure, there are heaps of people who believe that all mental disorder is a biological disease of the brain (see Deacon’s paper above and mine here for lists of quotes) but believing is not the same as proving. They may believe it but, if philosopher Daniel Stoljar is right (and he usually is), they’re wasting their breath: there never will be a physical account of mental disorder.

In place of the shadowy “biomedical model,” the Guidance proposes a human-centred, rights-based, community-based and accountable psychiatry. The other two chapters are a minutely detailed exposition of how mental health acts should be written and tested for compliance with the CRPD and the other eight relevant treaties in order to achieve this far-reaching goal.

This imposing publication leads inevitably to two conclusions:

    1. Psychiatry is routinely, systematically breaking practically every internationally-sanctioned law and treaty on human rights, entirely without scientific warrant; and
    2. Psychiatrists apart, the world is moving away from the idea that, when dealing with the mentally troubled, forms and standards of management from a hundred years ago are just fine.

This is the dilemma: according to the preeminent health and rights bodies in the world, psychiatry has to change. How much? This much: “Denial of legal capacity, coercive practices and institutionalization must end.” So far, nobody has told the psychiatrists and, as my little interchange with the editors showed, they’re not particularly interested. However, knowing psychiatrists, they will fight tooth and nail to resist change, and so the irresistible force meets the immovable object.

Psychiatry’s goal, as we know too well, is to medicalise everything they can get their pudgy hands on. Anybody who doesn’t like this is obviously “anti-psychiatry” (not to mention dangerous, biased, extremist and a tool of the scientologists). While the UN bodies will do the right thing, consulting widely and slowly building their case, we know that, at the slightest hint of a threat, the psychiatry/drug company axis will run squealing to their friends in government to drop a very large hammer on the upstarts.

There’s no doubt that mainstream psychiatry worldwide will have a collective fit when they see what non-psychiatrists have planned for them. There’s also no doubt that moving to the model of practice envisaged in the Guidance will require wrenching change in psychiatry. For a start, every national training program would have to be rewritten in its entirety, but the biggest resistance will come from the attitudes and belief systems of the establishment. Change of this nature would take years and years to put into practice. In fact, many of the older crew wouldn’t be able to adjust and would have to be dropped off at the old folks’ home.

But we can be sure of one thing: given its record, institutional psychiatry will not give in with good grace. I mean, look at the journal editors: they don’t even want to know the WHO or OHCHR exist. They don’t realise that the Guidance, as as issued recently, is a gun pointing at psychiatry’s collective head. It’s not an encouraging start.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion‚ÄĒbroadly speaking‚ÄĒof psychiatry and its treatments. The opinions expressed are the writers’ own.

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27 COMMENTS

  1. I am honored to have “first comment” to my old ‘friend” Niall McLaren. I can’t recall exactly WHICH CASE first publicised and introduced me to him, but I believe that the VICTIMS name was “Daniel”, and his case included forced electro-cution torture, (“ECT”), forced drugging with potent neuro-toxins, and being forcibly strapped down to beds, tables and chairs. In other words, par for the course of the pseudoscience drug racket and social control mechanism known as “psychiatry”.
    Only newer readers here at MadinAmerica will be totally unfamiliar with my comments and views. I have written 100’s of comments over many years here. And I have told my story. I am a surviving victim of the LIES of psychiatry. But I hold no animus against Niall McLaren. He’s one of the FEW GOOD GUYS in psychiatry; – most psychiatyrists are literally a personification of human EVIL. Yes, the “E” word. Psychiatry and psychiatrists are largely EVIL PEOPLE. They are ignorant and greedy and uncaring. Go ahead and protest, you acolytes and choir boys of psychiatry. You wouldn’t exist at all, if you didn’t $ell drug$ for PhRMA, at huge profit to investors & Wall St.
    This WHO-UN report doesn’t go far enough. We need a clarion call. We need to eliminate & eradicate the scourge of “biopsychiatry”, neuro-toxins masquerading as “medicines”, coercive so-called “treatment”, and the evils of psychiatry itself…..
    I am anti-homicide, anti-rape, anti-violence, and anti-psychiatry. But at least I’m honest, and consistent in my beliefs.
    You want to challenge me?
    Contact me through my website:
    votebradfordhutchinsonmayor.com

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    • “most psychiatyrists are literally a personification of human EVIL”. Bradford, you nailed it with this comment with my experience with a psychiatrist. Nailed it to a tee! Thank you and thanks MIA for this piece by Niall McLaren, very revealing in so many ways.

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  2. “The nature of illusion is that it’s designed, at least at the moment, to make you feel good about yourself, about your country, about where you’re going. In that sense it functions like a drug. Those who question that illusion are challenged not so much for the veracity of what they say, but for puncturing those feelings.”

    “The corporate state has made a war against critical thinking, and in particular the humanities because the humanities at their best are about teaching people how to think rather than what to think, they’re about teaching people to challenge assumptions and structures. The discipline of the humanities IS subversive, it’s MEANT to be subversive…”

    The corporate state knows no limits at this point: it has no regulation, it has no government control, it writes its own laws, it writes its own legislation so that the rise of popular culture and the obliteration of real culture is part of this entire corporate totalitarian assault on beauty and truth. And that’s what they have to seek to eradicate because those forces are ones that remind us about how we should live and about what it means to be human.” – Chris Hedges from “American Psychosis”

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  3. “The other thing that the failure to think critically does is it creates a very frightening historical amnesia, so you don’t know how you got here, you don’t know where you came from, and again that is something that popular culture, let’s call it totalitarian capitalism, seeks to put in place so that people interpret their problems as ‘personal’ problems rather than political or social problems.” Chris Hedges, from “American Psychosis”

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  4. Thank you Dr. McLaren, this is a masterpiece.

    “The Guidance proposes a human-centred, rights-based, community-based and ACCOUNTABLE psychiatry”.

    Yes, there must be ACCOUNTABILITY:

    Accountability for misdiagnosis of psychotropic Adverse Drug Reactions (ADRs) as ‘Serious Mental Illness’ (SMI).

    Accountability for misdiagnosing their drug induced AKATHISIA as ‘mental illness’ in those who do not have, and never have had any mental illness, yet were incarcerated and force-drugged leading to life changing multi-systems iatrogenic injuries, social isolation, economic destruction and unemployment resulting from irremovable ‘Labels for Life’.
    Labels which destroy marriage opportunity and child-bearing opportunities.

    Accountability for all those who are physically, psychologically, emotionally and financially damaged by drugs, and by deprivation of liberty in detention centres (allegedly ‘hospitals’).

    There must be financial accountability, and apology.

    Those damaged, destroyed or not surviving must be recognised.

    Misdiagnoses MUST be corrected in clinical records and there MUST be an end to denial of diagnostic error, and hence a decreased risk of subsequent rejection of the patient in primary care when expert second psychiatric opinion and monitoring of trajectory confirms diagnostic error.

    The title ‘Doctor’ carries a requirement for ACCOUNTABILITY, for Duty of Candour, and for a commitment to achieving Fair, Full and Informed Consent.

    No wonder your article was unwanted.

    As it stands: Psychiatry means never having to say you’re sorry.

    It is recognised that there are some Doctors of Conscience, Compassion and Empathy in psychiatry. They are respected. We need more.

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  5. CORRECTION: “The corporate state has made a war against HUMANITY (not “the humanities”), and in particular the humanities because the humanities, at their best, are about teaching people how to think rather than what to think…” Chris Hedges, American Psychosis

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  6. I recently attended a dedication of a monument to 700+ people who died in a Massachusetts state hospital and buried with no marker of any kind. It was attended by psychiatrists, mental health workers, and community members. The entire project was created and pushed along by a friend who has spent many days in hospitals himself. The state did not want to spend the money for such unnecessary people.

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  7. A trenchant and succinct article Dr. McLaren. Thank you!

    I don’t believe the degree or amount of substantive and reparative mental health care that psychiatry’s medical model utterly “forecloses”, can either be overstated or underestimated for the social damage it’s causing. Unchanged, psychiatry’s medical model stands to produce a significant destabilized population in the coming decades, and do so in one of the most destabilizing epochs in human history.

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  8. Thank you, Niall, great read. The document: ‘Mental Health, Human Rights and Legislation: Guidance and Practice’ is an important read for anyone working within the Disability, Aged Care and Mental Health (DAM) sectors, impacted by psychiatry, under the guise of care.

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  9. I was chuffed when I first read of this report but now realise that yes it will take years, or decades to make a difference, or just be ignored when the time comes.
    I am also worried that the States in Australia are not signatories to the CRPD and its the State Mental Health laws that need changing.
    Will they continue to assert that there is something biological there that they are treating with these poisons?
    It’s a nightmare being forced treated on a CTO. These changes can’t be implemented fast enough for most of us.
    Psychiatry is a scam, Forced treatment must be abolished

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  10. I was recently briefed on this UN document.

    It is encouraging that some thinking people realize how criminal the psychiatric profession has become.

    But that awareness alone won’t stop them. The UN has given us some good propaganda tools that can be used to reduce the power of psychiatric criminals. But is not enough to guide us totally out of this trap and into a better understanding of the mind and life. Defeating psychiatry as we know it is only the first step in what will probably be a very lengthy process.

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  11. “Why does the myth persist? …to some degree it persists because those who wield power in the United States, whether we’re talking political power, economic power, those who wield power have an interest in sustaining the myth because as long as the myth persists, so does their elevated status.” – Andrew Bacevich, from “Bidding farewell to the American century | The Chris Hedges Report, courtesy The Real News Network

    I think this statement applies to more than statecraft. So…is it any wonder that the myth of “psychiatry” insists on persisting?

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