Global reforms fall short as psychosis care still brings abuse, coercion and exclusion
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People with psychosis continue to face abuse, discrimination and early death despite global reform efforts to protect their human rights, according to La Trobe University researchers.
An international review published in The Lancet analyzed more than 350 research papers across 35 years, finding a persistent gap between global human rights commitments and the lived reality experienced by people with psychosis in low- and middle-income countries.
La Trobe Associate Professor of Law and co-lead author Dr. Piers Gooding said people living with psychosis continue to face widespread human rights violations, including coercive treatment, confinement and systemic discrimination across institutional care and community settings.
"In many countries, people with psychosis are still being chained, detained or treated against their will," Gooding said.
"In some settings, coercive practices including involuntary arbitrary detention, sterilization and confinement in institutions remain common and are often legally sanctioned.
"People in minority groups who face discrimination because of gender, age, ethnicity or socioeconomic background also tend to experience greater rates of coercion."
Reforms failing in practice
Despite countries signing on to international frameworks such as the UN Convention on the Rights of Persons with Disabilities (CRPD), the review shows legal reforms have often failed to translate into meaningful, practical changes for people with mental ill health and disabilities.
The review, which screened 7,953 records from 1990 to 2025, also highlights stark health inequalities. People with psychosis and chronic health conditions die up to 10 to 15 years earlier than the general population, largely because of systemic issues related to untreated physical health problems and poorer access to care.
"Integration of mental health care into universal health coverage is vital for improving access to appropriate health services for individuals with psychosis," Gooding said.
"Successful models in Latin America, such as the scale-up of community-based services in Chile and the legislative reforms in Brazil, suggest that integrating psychosis care into universal health care is feasible even in resource-constrained environments."
Exclusion extends beyond health care
The review shows people with psychosis are more likely to be excluded from employment and housing opportunities. In some countries, people with psychosocial disabilities also continue to face restrictions on civil rights such as voting, marriage and property ownership.
"Psychosis and poverty are also closely linked, creating a cycle of socioeconomic disadvantage that systemically contributes to and worsens mental ill health."
Gooding said advancing the rights of people with psychosis requires coordinated legislative, policy and community-based action to align national laws with the UN CRPD, end discrimination and coercion, strengthen community inclusion, and promote access to and investment in universal health care.
"People with personal experience of psychosis must be at the center of designing services and policies that affect them. Without their voices, reforms will continue to fall short," Gooding said.
"This is ultimately about dignity, autonomy and equal rights, which enable people with psychosis to access appropriate care and lead fulfilling lives in their own communities."
Publication details
Piers Gooding et al, Psychosis, human rights, and legal frameworks: global perspectives, with a focus on low-income and middle-income countries, The Lancet Psychiatry (2026). DOI: 10.1016/s2215-0366(26)00156-2
Journal information: The Lancet Psychiatry , The Lancet
Key medical concepts
nonorganic psychosisChronic DiseaseSterilization
Clinical categories
PsychiatryPsychology & Mental health Provided by La Trobe University Who's behind this story?
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