Images of people incarcerated, unkempt and kept in chains, mocked, and uncared for dominate the history of psychiatry, particularly from the middle ages to the early 20th century. Locked up for years, and forcibly sedated or sterilised, those with mental ill health were subject to inhumane conditions and removed from society, often under the supervision of doctors. What of now? How have things improved for those with mental illnesses?


“Human rights abuses and forced institutionalisation remain commonplace”


On Jan 16, a new report was published by Mental Health Europe and the Tizard Centre, University of Kent, on the state of mental health services across Europe. Mapping and Understanding Exclusion: Institutional, Coercive and Community-Based Services and Practices Across Europe documents what is current practice in mental health systems in 36 European countries from a health and a human rights perspective. While there has been some progress since 2012, when a previous Mapping Exclusion report was published, human rights abuses and forced institutionalisation remain commonplace.

Personal testimonies are an important part of the report. They document the use of physical restraint, involuntary hospitalisation, electroconvulsive therapy, the pressure to sign consent forms for admission or treatment, the absence of information given, and social isolation. Dehumanisation, objectification, and lack of even basic care are common themes. Issues of access to toilets, soap and water, heating, and healthy food are described by patients from France, the Netherlands, Greece, Spain, and Serbia, while in Ireland one patient documents that “adult nappies hanging on the handle of the seclusion room door was a dark reminder of what can happen to you” (The Lancet, 1 27 2018).

From our Observatory of Bioethics, we ask, why is the care of the mentally ill being neglected in the European community?

See WHO report  “A global human rights emergency in mental health