Psychiatric Abuse Form - Citizens Commission on Human Rights Ireland

Harmed by psychiatry? Tell your story and report psychiatric abuse here. This is your chance to tell the story about what happened to you or your friend/family member in the psychiatric system. Any information you give on this form will be treated in the strictest confidence.

Your email address *

Confirm Email

Are you the abused person?

Details of the abused person *

First

Last

Telephone number

Age

Gender

Male
Female

Your details (if reporting about someone else) *

First

Last

Your telephone number

Your relationship to the abused person

Details of the abuse

Summary of abuse that occurred *

Approximate date the abuse occurred

Approximately how many times?

Facility where the abuse took place

What county is the facility in?

Name of doctor(s)/psychiatrist(s) involved

Any other information you would like to give?

Approximate facility of

What would you like to achieve as a result of reporting this abuse?

Thank you for your data.

Would you like to receive news from the Citizens Commission on Human Rights Ireland?

Yes, please.
No, thank you.

Confidentiality

Your information is kept strictly confidential and will only be used with your permission. Therefore, please let us know your intentions:

Please make your choice: *

I hereby authorise the Citizens Commission on Human Rights (CCHR) to conduct an investigation into this case.
Or: I do not wish any action to be taken. The details of my treatment are being sent as information only.

General Data Protection Regulation (GDPR)

Additionally, to comply with the General Data Protection Regulation, an EU privacy and human rights law that protects your data and privacy, we need your explicit consent to store and process your data.

Details of the abuse

Newsletter

Confidentiality

General Data Protection Regulation (GDPR)