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.

BackgroundVideo-algorithmic patient monitoring (VAPM) combines remote, noncontact sensors and algorithmic analysis and is increasingly trialed in acute psychiatric and other care settings. While promoted for improving safety and reducing risk, it raises ethical concerns regarding safety, privacy and surveillance. Little is known about how those encountering VAPM in mental health care contexts anticipate its use and potential impacts, including where it has not yet been implemented. ObjectiveThis study aimed to explore the views of patients or mental health consumers, specialized mental health nurses and nurse academics, hospital managers, and technology vendors regarding the appropriateness and anticipated implications of VAPM in mental health inpatient care. MethodsThis qualitative study identified key stakeholders in Australia via networking techniques for participation in a deliberative workshop. A deliberative workshop was held, and the workshop discussion was audio-recorded, transcribed, and thematically analyzed, consistent with methods in health technology research, which enable exploration of different viewpoints, including convergences and divergences across stakeholder groups. ResultsIn total, 16 stakeholders participated, exploring themes concerning (1) contestation over the rationale for VAPM in mental health settings, (2) VAPM reshaping care and relationships, (3) perceived harms of VAPM, (4) perceived observational support for safety and reduced disruption, (5) serious privacy implications of VAPM, (6) the need for appropriate governance, and (7) the potential for VAPM to transform, not augment, service delivery. General views differed across groups. Patients or service users expressed concerns about privacy, coercion, and the potential to intensify stigma. Mental health nurses were cautious but interested in possible benefits for safety and suicide prevention. Hospital managers and technology vendors largely emphasized safety gains. ConclusionsThe findings suggest that the anticipated risks of VAPM are primarily experienced subjectively, as infringements on privacy, dignity, and trust, while purported benefits remain largely untested and unquantified. From a utilitarian perspective, direct comparison is therefore difficult—the risks are set out in the anticipated experiences of those with lived experience, and the benefits remain hypothetical. From this view, robust, independent evidence of real-world outcomes is required. Yet, for some participants, the very premise of such calculation was rejected, with privacy, dignity, and trust regarded as nonnegotiable, rather than items for trade-off. If VAPM is to be pursued at all, it should proceed only with extreme caution, with transparent evidence of outcomes, and with meaningful participation from those whose lives and care are most directly impacted.

Lived experience engagement is becoming a growing expectation in research. However, in the higher education sector, academic researchers and teaching staff may lack the skills and confidence to engage lived experience experts. This study is an evaluation of a mentoring program for staff at an Australian university developed in order to build capacity to engage lived experience experts in teaching and research. The program paired staff who wished to improve their engagement with lived experience experts with staff who had substantial experience in this domain. Following the conclusion of the program, we conducted a survey and interviews with mentees and mentors in the program to understand what impact, if any, the program had on their capability to engage lived experience experts in their work. 13 program participants completed the survey and 14 participated in an interview. We followed a realist evaluation approach to study design and analysis of the data, producing 5 Context-Mechanism-Outcome configurations. Overall, our analysis suggested that the program had strong effectiveness in building the confidence of mentees. Effectiveness was limited when mentees did not have a current or future project planned. Success also seemed to be determined by the relational aspect of the mentoring. This study advances a realist account of mentoring by specifying how relational conditions function as generative mechanisms for researcher capacity building in lived experience engagement. Rather than treating trust and flexibility as background enablers, the analysis demonstrates how mechanisms activate under conditions such as epistemic alignment. In doing so, the study contributes to evaluating relational interventions within research institutions, broadening attention from individual capacity building to explore the conditions under which epistemic change becomes possible. Our research suggests that future similar programs should be developed, implemented and evaluated in order to support lived experience engagement in research.

Since the introduction of the Convention on the Rights of Persons with Disabilities (CRPD), there have been calls to develop standards for evaluating compliance and implementation. Human rights ‘indicators’ are a recognized, if somewhat contested, way to measure states' compliance with human rights treaties. The additional CRPD requirement for active involvement of people with disabilities in monitoring and implementation has sparked efforts towards participatory design of such tools. We present a rationale for the development of a CRPD indicator in the mental health context. We adopted a combined doctrinal analysis and scoping review approach to examining literature on human rights indicators. Unsurprisingly, a much wider literature exists on indicators concerning the rights of people with disabilities generally. For mental health-focused efforts, compliance tools have focused on either (1) the implementation of specific CRPD provisions, (2) mental health-related legislation, or (3) consisted of audit and service quality assessment tools that consider human rights at the service level. We observe that no tools or indicators have been developed in the mental health context that include a full, integrated assessment of the CRPD across society (both including and extending beyond healthcare services to include areas like housing, employment, and anti-discrimination law). To address this gap, we conclude by proposing the development of a co-designed indicator that is inclusive of the full spectrum of rights contained within the CRPD.

Around the world, peer-run, bed-based services that offer voluntary support to people experiencing mental health crisis are emerging as alternatives to hospital-based mental healthcare. In Victoria, Australia, where these 'alternative crisis services' are expanding, a key legal question has arisen: must non-coercive settings adopt the suicide prevention architectural design (or 'anti-ligature design') mandated in psychiatric wards under negligence and occupational health and safety laws? This article answers that question through a three-stage study: (1) a doctrinal analysis of Victorian case law and statutes that shape duties to prevent suicide; (2) a narrative review of evidence on anti-ligature measures in hospital environments; and (3) thematic analysis of interviews with clinicians, designers, peer leaders and legal experts (n = 12). The findings indicate that empirical evidence only associates anti-ligature design with reduced suicide rates when paired with search, detention and close observation powers, which are absent from alternative crisis services. There was no evidence identified that anti-ligature design will reduce suicide in settings which do not also implement these practices. This absence of data does not justify retreat to institutional templates, especially considering key differences in the care models that differentiate alternative crisis services from traditional hospital-based offerings. Interviewees warned that conspicuous anti-ligature hardware can undermine the therapeutic value of alternative crisis services, and merely displace, rather than prevent, suicidal behaviour. Wholesale transplantation of hospital anti-ligature standards into alternative crisis services is therefore unlikely to satisfy the 'reasonableness' test and may contravene the therapeutic mandate of services. Instead, this study calls for regulators to endorse context-specific standards for mental health service design, some of which may require further empirical research on rights-based, peer-led safety strategies.

Video-algorithmic patient monitoring (VAPM) combines remote, non-contact sensors and algorithmic analysis, and is increasingly trialled in acute psychiatric and other care settings. While promoted for improving safety and reducing risk, it raises significant ethical concerns regarding privacy and surveillance. Little is known about how those encountering VAPM in mental healthcare contexts perceive its use and potential impact. This study aimed to explore the views of patients/mental health consumers, specialised mental health nurses and nurse academics, hospital managers, and technology vendors regarding the appropriateness and implications of VAPM in mental health inpatient care. This qualitative study identified key stakeholders in Australia via networking techniques for participation in a deliberative workshop. A deliberative workshop was held, with audio recorded, transcribed and thematically analysed, consistent with methods in health technology research, which enable exploration of different viewpoints, including convergences and divergences across stakeholder groups. 15 stakeholders participated, exploring themes concerning (1) contestation over the rationale for using VAPM in acute psychiatric settings; (2) humanising versus dehumanising effects; (3) perceived harms; (4) risk and protection; (5) support for observational assistance; (6) privacy implications; (7) the need for appropriate governance; and (8) potential service transformation. General views differed across groups. Patients/service users expressed concerns about privacy, coercion, and the potential to intensify stigma. Mental health nurses were cautious but interested in possible benefits for safety and suicide prevention. Hospital managers and technology vendors largely emphasised safety gains. Conclusions The findings suggest that the risks of VAPM are primarily experienced subjectively, as infringements on privacy, dignity, and trust, while purported benefits remain largely untested and unquantified. From a utilitarian perspective, direct comparison is therefore difficult – the risks are tangible in lived experience, whereas the benefits are still hypothetical. From this view, robust, independent evidence of real-world outcomes is required. Yet, for some participants, the very premise of such calculation was rejected, with privacy, dignity, and trust regarded as non-negotiable, rather than items for trade-off. If VAPM is to be pursued at all, it should proceed only with extreme caution, with transparent evidence of outcomes, and with meaningful participation from those whose lives and care are most directly impacted. N/A

INTRODUCTION:Mental health legislation authorises involuntary psychiatric intervention in certain circumstances. Although human rights concerns are becoming more prominent, debates among legal experts, clinicians and activists continue to swirl around people's rights to equal recognition before the law, such as described in the (United Nations Convention on the Rights of Persons with disabilities, 2006). AIM:This qualitative descriptive study aimed to better understand diverse views of people known to hold a critique of coercion in mental health services, on the practical expression of upholding human rights in the context of mental health laws. METHOD:Individual semi-structured interviews were conducted with 15 key informants from five different countries and data was analysed using an inductive, thematic approach. RESULTS:Overall, informants characterised mental health laws as discriminatory, harmful and unjustifiable. Three themes and six sub-themes were identified. This study reports on the major themes which include: an ethical position (focusing on the present harms associated with mental health laws), strategies, (an expression of the opportunity to bring about change) and a visionary position. We explore these three features in the views of key informants as important positions in the field of abolition, and analyse each for the 'hermeneutic resources' - forms of collective interpretive resources - they provide. CONCLUSIONS:Abolition of mental health laws is often seen as not feasible in the context of psychiatry. However, abolition theories and practices are hermeneutic resources that need to be better understood because they offer social justice and community-led solutions beyond mental health laws and systems.

Digital mental health services in Australia have grown rapidly since the COVID-19 pandemic and continue to attract public and private investment. Yet, ambiguity remains about which regulatory bodies are responsible for addressing the 'significant risks' noted in Australia's National Safety and Quality Digital Mental Health Standards. These risks include threats to privacy, safety, and data security. This Practice and Policy note makes recommendations based on a mapping of Australian regulators potentially involved when a digital mental health service is found to pose such a risk. In practice, an average of three regulators may be relevant for each area of risk, and more than double in some instances. Such complexity can confound clarity about where to lodge complaints or concerns, and how any identified 'significant risk' is to be managed. This paper proposes ways to clarify referrals between the Australian Commission on Safety and Quality in Health Care, accrediting agencies, and other key regulators and recommends (1) further regulatory mapping and planning, (2) clearer complaints and feedback pathways, and (3) an evaluation of current regulatory infrastructure to ensure fitness for purpose.Points for practitioners Uncertainty currently exists about which bodies oversee different aspects of digital mental health service regulation in Australia. The National Safety and Quality Digital Mental Health Standards are world-leading, but there is a need to confirm referral pathways for risks that arise during service accreditation. Clearer public complaint and feedback procedures would benefit service users, care providers, and regulators alike. Robust oversight and accessible complaints channels will help Australia maximise the benefits of digital innovations in mental health care while minimising harm.

This article examines Indonesia's guardianship system for persons with psychosocial disabilities (PPDs) following the country's ratification of the Convention on the of Persons with Disabilities (CRPD). Despite this ratification, Indonesia continues substitute decision-making framework, violating CRPD principles. Analyzing 49 decisions from 2015 to 2018, the study identifies issues such as outdated criteria guardianship, inappropriate involvement of religious courts, and the use of insufficient evidence during hearings. Focus group discussions with PPDs, caregivers, and reveal fears and hardships faced under the current system. The findings indicate applications are granted without thorough consideration, often based on inadequate evidence. The article calls for legal reforms to align with CRPD mandates, advocating for a supported decision-making framework to protect PPDs' rights and autonomy. Indonesia must adopt a contemporary understanding of capacity to ensure retain their legal capacity and receive necessary support.

Risk assessment is an important component of judicial decision-making in many areas of the law. In Australia, those convicted of terrorist offences may be the subject of continued detention in prison or extended supervision in the community if there is an "unacceptable risk" of them committing future terrorism offences. Forensic psychologists and psychiatrists may provide evidence of risk through identifying and measuring risk factors with the aid of tools that use scales based on statistical or actuarial risk prediction. This column focuses on criticisms of the use of the second revision of the Violent Extremism Risk Assessment tool (VERA-2R) in determining the risk of future terrorist acts.

Background Digital tools have the capacity to complement and enhance clinical care for young people at risk of suicide. Despite the rapid rise of digital tools, their rate of integration into clinical practice remains low. The poor uptake of digital tools may be in part due to the lack of best-practice guidelines for clinicians and services to safely apply them with this population. Methods A Delphi study was conducted to produce a set of best-practice guidelines for clinicians and services on integrating digital tools into clinical care for young people at risk of suicide. First, a questionnaire was developed incorporating action items derived from peer-reviewed and grey literature, and stakeholder interviews with 17 participants. Next, two independent expert panels comprising professionals (academics and clinical staff; n = 20) and young people with lived experience of using digital technology for support with suicidal thoughts and behaviours (n = 29) rated items across two consensus rounds. Items reaching consensus (rated as “essential” or “important” by at least 80% of panel members) at the end of round two were collated into a set of guidelines. Results Out of 326 individual items rated by the panels, 188 (57.7%) reached consensus for inclusion in the guidelines. The endorsed items provide guidance on important topics when working with young people, including when and for whom digital tools should be used, how to select a digital tool and identify potentially harmful content, and identifying and managing suicide risk conveyed via digital tools. Several items directed at services (rather than individual clinicians) were also endorsed. Conclusions This study offers world-first evidence-informed guidelines for clinicians and services to integrate digital tools into clinical care for young people at risk of suicide. Implementation of the guidelines is an important next step and will hopefully lead to improved uptake of potentially helpful digital tools in clinical practice.

The practice of coercion in mental health care is a critically important point of discussion for international human rights bodies, governments, professional bodies, lived-experience representative organizations, and for individuals living with mental illness and their families and carers. This article aims to provide a balanced overview and exploration of the history of coercive practices in psychiatry, current international practices, key ethical, human rights, and legislative considerations, current efforts to develop, investigate, and promote alternatives to coercion, and international recommendations for the future of mental health care. The article highlights current challenges, limitations, and opportunities for further research to enrich the field of study in the intersection of human rights and mental health. We conclude by emphasizing the essential need for mental health promotion and prevention of mental disorders by strengthening primary mental health care and interventions aimed at addressing the social determinants of mental health with a holistic response incorporating all sectors of government services and nongovernmental organizations.

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.