Often people who seek help from psychiatrists, psychologists and other mental health workers, are falsely diagnosed and forced to undergo unwanted and harmful psychiatric treatments, such as psychiatric drugs which are documented to cause serious side effects, involuntary commitment, or electroshock.

If you know anyone whose mother, wife, sister or father, brother, son, child or friend has been killed or damaged by psychiatric “treatment” please fill out the form below with full particulars and any documentary evidence.

Report Psychiatric Abuse

First Name of the Abused *

Last Name of the Abused *

Street Address *

Address Line 2

City *

State / Province / Region *

ZIP / Poastal Code *

Country *

Phone *

Email *

Date of Birth: mm/dd/yyyy

Age

Anyone else involved? Please list their names:

How did you find out about us?

What was happening with yourself (or the person involved) immediately prior to, or at, the time the incident/abuse started?

Describe the abuse that occurred and include all dates:

Were you (or the person involved) seen by a mental health practitioner, school psychologist, or psychiatrist? When? What was the result?

Names of any mental health personnel involved and their professional titles:

Names of any mental health hospitals/facilities involved:

Were you (or the person involved) threatened or otherwise coerced to accept any psychiatric or psychological treatments?

What treatment was prescribed? If it was psychiatric drugs, name the drug, the dose and the reason this was recommended:

Did you (or the person involved) experience any adverse reaction from the treatment? Provide details:

Are you (or the person involved) still taking any psychiatric drugs or receiving psychiatric treatment?Are you (or the person involved) still taking any psychiatric drugs or receiving psychiatric treatment?YesNo

If yes, please provide details on what psychiatric drugs and/or psychiatric treatment:

Any other information that you would like to tell us, or feel is important to the case?

Today's Date mm/dd/yyyy

Your First Name

Your Last Name

What actions are you interested in taking on this case:What actions are you interested in taking on this case:Having CCHR further investigate this case.Having complaints filed on your/another's (with their permission) behalf with the proper authorities.Assisting in obtaining legislation in your state on issues that address the type of abuses in this case.Writing letters to Congress on these abuses.Starting or getting involved in a support group for people who have suffered similar abuses.Other

6 + 2 =

Citizens Commission on Human Rights of Colorado

GET THE FACTS.

TAKE ACTION.

FIGHT BACK.

Report Psychiatric Abuse

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