Institutional Corruption and the Right to Mental Health
In their 2025 article Institutional Corruption and the Right to Mental Health: Lessons from Eastern Europe and Beyond, Dainius Pūras and Julie Hannah offer a critical reflection on why mental health policies so often fail at the stage of implementation. Published in Health and Human Rights, their analysis reframes these failures not as technical shortcomings or resource gaps, but as manifestations of institutional corruption — systemic, lawful, and normalized influences that divert institutions away from their foundational purpose of protecting human dignity and well-being.
The authors define institutional corruption broadly, emphasizing that it does not require illegality or individual misconduct. Rather, it arises when mental health systems become structurally dependent on particular professional interests, funding streams, and epistemic frameworks—most notably the dominance of biomedical psychiatry and pharmacological interventions. These dependencies shape priorities, research agendas, and service models in ways that marginalize psychosocial, preventive, and community-based approaches, even when human rights commitments are formally acknowledged in policy documents.
Eastern Europe as a Bellwether
Central and Eastern Europe serves as the article’s primary case study and analytical lens. Pūras and Hannah describe how Soviet-era mental health systems were deeply entangled with authoritarian governance, marked by institutionalization, lack of transparency, and practices that enabled political abuse of psychiatry. Although the political context changed dramatically after the early 1990s, the authors argue that many of the structural features of these systems persisted, shaping post-transition reforms in subtle but consequential ways.
The social and economic upheaval following the collapse of the Soviet Union produced widespread psychosocial distress and a dramatic rise in mortality across the region. In response, international advisers and donors frequently promoted solutions grounded in Western biomedical psychiatry, particularly the expanded diagnosis of depression and large-scale use of newer psychotropic medications. Pūras and Hannah contend that this approach exemplifies institutional corruption: it reframed collective, structural suffering as individual pathology, reinforced professional hierarchies, and diverted resources away from social protection, community supports, and rights-based services.
Drawing on concrete examples, including reforms in Lithuania, the authors show how apparent progress—such as the establishment of outpatient clinics or formal deinstitutionalization policies—can coexist with persistent overmedicalization, continued reliance on coercion, and resistance to independent monitoring. In such contexts, reform remains largely cosmetic, leaving the underlying institutional logic intact.
Global Patterns of Distortion
While grounded in Eastern European experience, the article’s argument extends far beyond the region. Pūras and Hannah situate these developments within a broader global trajectory marked by optimism about biological psychiatry in the late twentieth and early twenty-first centuries. Promises of breakthroughs in neuroscience and psychopharmacology helped justify the concentration of funding and authority within a narrow biomedical paradigm. When these breakthroughs failed to deliver transformative improvements in population mental health, the resulting disappointments did not lead to systemic reorientation, but rather to deeper entrenchment of existing models.
The authors also identify a “corruption of knowledge,” in which selective evidence, weak regulation of conflicts of interest, and imbalances in research funding shape what counts as legitimate expertise. This distorted knowledge base feeds directly into policy design and implementation, reinforcing cycles of institutional dependency and limiting the space for alternative, rights-affirming approaches.
Human Rights and System Transformation
A central contribution of the article is its integration of human rights law into the analysis of mental health policy. Pūras and Hannah link institutional corruption to persistent violations of legal capacity, autonomy, and freedom from coercion, particularly in light of international obligations under disability rights frameworks. They argue that closing a so-called “treatment gap” is insufficient—and potentially harmful—if it simply expands access to coercive or overmedicalized services.
Instead, the authors call for system transformation. This entails rebalancing power relations within mental health systems, investing in community-based and peer-led services, strengthening accountability mechanisms, and grounding policy decisions in non-biased evidence that reflects lived experience. Confronting institutional corruption, they conclude, is not an abstract ethical exercise but a practical necessity for realizing the right to mental health.
Conclusion
Pūras and Hannah’s article offers a compelling reframing of persistent failures in mental health policy implementation. By naming institutional corruption as a central obstacle, they move the debate beyond questions of efficiency or coverage and toward a deeper interrogation of values, power, and purpose. Their analysis underscores that meaningful reform requires more than new policies or increased funding; it demands a sustained commitment to human rights, structural change, and the reorientation of mental health systems toward the people they are meant to serve.
Dainius Pūras, MD, PhD, is a professor in public mental health and child and adolescent psychiatry, Faculty of Medicine, Vilnius University, Lithuania.
Julie Hannah, LLM, is a lecturer in law at the Law School and Human Rights Centre, University of Essex, United Kingdom.
