Psychosis, human rights, and legal frameworks: global perspectives, with a focus on low-income and middle-income countries.

Abstract

The rights of people with psychosis continue to be violated globally, often through practices that are legally and socially sanctioned, including coercive treatments and systemic discrimination. The Convention on the Rights of Persons with Disabilities (CRPD) has catalysed attention to rights-based mental health policy and practice, yet substantial gaps remain between international standards and lived realities. We conducted a systematic search of the literature and a structured narrative synthesis of global evidence on psychosis, human rights, and legal frameworks, focusing on low-income and middle-income countries. We identified 352 papers, organised into four thematic areas: coercion, violence, and abuse; discrimination; community inclusion and participation; and universal health coverage (UHC). Coercive practices persist across settings, ranging from formally authorised involuntary interventions to shackling and community confinement where services are limited. This persistence reflects both structural inequities and ongoing challenges in adequately responding to the needs of people with psychosis during acute crises, whether under long-standing medicolegal frameworks or in transition towards CRPD-aligned approaches centred on respecting people's rights, will, and preferences. Individuals with psychosis experience widespread structural discrimination affecting health care, employment, housing, and civic participation, contributing to poorer health outcomes. Social exclusion and poverty undermine recovery, and fragmented health systems and stigma impede equitable access to care within UHC frameworks. Advancing the rights of people with psychosis requires coordinated legislative, policy, and community-based action. Aligning national laws with the CRPD, strengthening supported decision making, investing in community services, integrating mental health into UHC, and promoting active participation of people with lived experience of psychosis are crucial steps towards enabling full societal inclusion. Systemic reform is essential to ensure that individuals with psychosis can live with dignity, exercise equal rights, and participate fully in their communities.