Global review reveals persistent discrimination against people with psychosis

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 analysed 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," Dr Gooding said. 

"In some settings, coercive practices including involuntary arbitrary detention, sterilisation, and confinement in institutions remain common and are often legally sanctioned. 

"People in minority groups who face discrimination because of gender, age, ethnicity or socio-economic background also tend to experience greater rates of coercion." 

Despite countries signing onto the international frameworks such as the UN Convention on the Rights of Person 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 7953 records from 1990 to 2025, also highlights stark health inequalities. People with psychosis and chronic health conditions die up to 10 or 15 years earlier than the general population, largely due to 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," Dr 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." 

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 socio-economic disadvantage that systemically contributes to and worsens mental ill health." 

Dr 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 to end discrimination and coercion, strengthen community inclusion and promote access and investment in universal health care. 

"People with personal experience of psychosis must be at the centre of designing services and policies that affect them. Without their voices, reforms will continue to fall short," Dr 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."