When Mental Health Care Becomes a Human Rights Crisis

A recent study published in the International Journal of Law and Psychiatry highlights a troubling gap between Spain’s mental health legal framework and service users’ lived experiences of human rights violations. Conducted by María Laura Serra, a faculty member at the University of Valladolid, the research exposes systemic failures that allow coercive psychiatric practices to persist despite existing legal safeguards.

Using a socio-legal approach, Serra critically examines Spain’s mental health laws alongside qualitative data from 38 interviews with psychiatric service users and stakeholders across seven autonomous communities. Her findings point to fundamental issues in judicial oversight, the use of coercion in psychiatric care, and the erosion of patient autonomy. While Spain has made efforts to align its mental health policies with human rights standards, systemic gaps remain.

“These complexities and challenges are not unique to Spain. Evidence shows that despite significant advancements in mental health service delivery worldwide, stigmatizing attitudes and human rights violations persist in mental health settings.”

Serra’s study contributes to growing international critiques of psychiatric coercion and its long-term harm to service users. The research underscores the need for mental health care models that prioritize autonomy, informed consent, and dignity—principles that remain aspirational rather than actualized in many psychiatric systems worldwide.

When Legal Protections Do Not Translate to Rights

One of the study’s key findings is the disconnect between Spain’s legal safeguards and how they are applied in practice. Article 763 of Spain’s Criminal Procedure Act outlines requirements for involuntary treatment, including judicial approval. However, interview participants reported that these legal processes often felt disempowering, with judicial intervention serving as a mere formality rather than a meaningful check on psychiatric power.

“They sat in front of me, but it didn’t matter what I said; they were never going to reverse the decision. The one speaking most of the time was the secretary, not the judge. When I asked them to identify themselves, they did, but it was clear my explanations didn’t matter. I gave my reasons for wanting to go home, but they just listened without responding. Later, I was told it was still involuntary.”

Participants described the judicial process as opaque, impersonal, and predetermined. Rather than serving as a safeguard against psychiatric coercion, the courts often functioned as an administrative rubber stamp, reinforcing service users’ sense of powerlessness.

Coercion in Voluntary and Involuntary Treatment

Serra’s analysis highlights how coercion is not limited to legally defined involuntary hospitalizations. Even individuals who voluntarily seek psychiatric care frequently encounter coercive practices, including forced restraint and sedation.

“Juana’s voluntary admission in Extremadura, which still resulted in her being tied up, raises critical questions about the autonomy of patients and the thresholds for invoking coercive measures: ‘I was admitted voluntarily, and I was tied up for the first 24-48 hours. The medication made me so dizzy that I had trouble getting up. The second day after being tied up for two days, they lifted me up to go take a shower, and I literally fell down…’”

This testimony underscores the blurred boundary between voluntary and involuntary care, revealing that even those who willingly enter psychiatric hospitals are not necessarily free from coercive measures.

Psychiatrists Admit to Manipulating Consent

The study also sheds light on how psychiatric professionals navigate the legal constraints on involuntary hospitalization. Several practitioners acknowledged using persuasive tactics to pressure patients into “voluntary” admissions, avoiding the bureaucratic hurdles of formal involuntary commitment.

“This view was in part echoed by an interviewed psychiatrist who admitted to using verbal persuasive tactics to avoid the bureaucratic hurdles of involuntary admissions: ‘I think that I have sometimes forced, let’s say, convincing someone for a voluntary admission.’ Such practices blur the distinction between voluntary and coerced consent, undermining the individual’s ability to make informed, autonomous decisions.”

These findings align with global critiques of psychiatric power, where “voluntary” admissions often serve as a legal workaround for coercion rather than a genuine expression of patient autonomy.

Humiliation and the Loss of Dignity

The study also reveals how psychiatric settings subject patients to degrading treatment, reinforcing a sense of dehumanization. Participants described experiences of forced nudity, enforced uniformity, and a loss of personal identity.

“Experiences of being forced to undress in front of staff and wear identical hospital pajamas were frequently cited by participants as forms of humiliating treatment. Cristina from Madrid, for instance, recounts: ‘The first thing they want is for you to undress, to see yourself naked from top to bottom, from head to toe in front of 6 people… I find it absolutely embarrassing.’”

Another participant, Aidee from the Canary Islands, shared an account of being restrained and denied access to a bedpan, further illustrating the degradation experienced in psychiatric institutions:

“Two times I was put in diapers. It’s very degrading… ‘Put a bedpan for me…’ ‘No, we’re not going to waste time with a bedpan, come on girl…’ ‘Yeah, we’re going to waste time to put a bedpan for you.’”

Such accounts highlight how psychiatric institutions, rather than offering care, often strip individuals of their autonomy and dignity, treating them as objects rather than persons deserving of respect.

A Call for Systemic Change

The findings of this study point to systemic inefficiencies, ongoing human rights violations, and a persistent reliance on coercion in Spain’s mental health system. Serra argues that these problems are not unique to Spain but reflect broader global patterns of psychiatric power and control.

“Such reforms must extend beyond procedural modifications and confront the systemic reliance on coercive practices, fostering a shift towards genuinely person-centred care that prioritises autonomy, informed consent, and dignity. Additionally, policy measures—such as improving staffing levels, rethinking care environment designs, and enhancing professional training—are essential to support this transformation.”

Centering Lived Experience: A Global Imperative

Serra’s findings echo concerns raised in other countries, including the U.S., where coercion remains deeply embedded in psychiatric systems. As Mad in America has previously reported, ignoring the lived experiences of service users erases vital perspectives that could transform mental health care. A recent book chapter emphasized the importance of historical and cultural narratives in challenging psychiatric dominance and rethinking mental health treatment.

Centering lived experience remains a critical call to action for those working to dismantle psychiatric oppression. As Serra’s research makes clear, real reform requires more than legal safeguards—it demands a fundamental shift in power, moving from coercion to consent, from control to autonomy, and from institutional authority to human dignity.

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Serra, M. L. (2025). ‘If someone had stopped to talk to me’: A human rights analysis of Spain’s mental health system. International Journal of Law and Psychiatry, 99, 102069. (https://doi.org/10.1016/j.ijlp.2025.102069)