CEDH · CASELAW;JUDGMENTS;CHAMBER;ENG — 5 juin 2025

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UKRAINE (Application no. 21180/15)   JUDGMENT   Art 5 § 1 • Unlawful continued compulsory hospitalisation of the applicant despite a court order to cease his compulsory inpatient psychiatric treatment Art 5 § 4 • Applicant’s inability to challenge the lawfulness of his compulsory psychiatric confinement • Findings in Gorshkov v.   Ukraine applicable • Domestic system at the time lacking basic safeguard of providing patients compulsorily detained in a psychiatric hospital an independent right to lodge an individual application with a court • Systemic problem • Compulsory hospitalisation in a mental care facility, as ordered by a criminal court, included automatic authorisation to treat patients against their will without a remedy • Periodic ex officio judicial review of the applicant’s case marked by a manifest lack of diligence and incompatible with basic justice requirements • Lack of an adequate judicial response Art 3 (substantive and procedural) • Positive obligations • Respondent State’s failure at the time to establish and apply effectively a legal and regulatory framework governing compulsory medical measures in psychiatric institutions and the investigation of complaints about such measures • Absence of procedural safeguards • Criminal authorities’ failure to investigate the applicant’s allegations Art 3 (substantive) • Inhuman and degrading treatment • No proven therapeutic necessity for persistent and prolonged daily administration of neuroleptic medication, in different forms and dosages, without a predetermined course and against the applicant’s will • Coercive medical treatment continued despite court order for its cessation • Treatment with a retaliatory aim and intended to exert control over the applicant’s behaviour • Lack of effective legal safeguards against arbitrariness and abuse by medical staff Art 3 (substantive) • Degrading treatment • Inadequate conditions of detention in the psychiatric hospital Art 13 + (Art 3) • Lack of an effective remedy   Prepared by the Registry. Does not bind the Court.   STRASBOURG 5 June 2025   FINAL   05/09/2025   This judgment has become final under Article 44 § 2 of the Convention. It may be subject to editorial revision. In the case of Spivak v. Ukraine, The European Court of Human Rights (Fifth Section), sitting as a Chamber composed of:   Mattias Guyomar , President ,   María Elósegui,   Gilberto Felici,   Andreas Zünd,   Kateřina Šimáčková,   Mykola Gnatovskyy,   Vahe Grigoryan , judges , and Victor Soloveytchik, Section Registrar, Having regard to: the application (no.   21180/15) against Ukraine lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Ukrainian national, Mr   Gennadiy Igorovych Spivak (“the applicant”), on 23 April 2015; the decision to give notice to the Ukrainian Government (“the Government”) of the complaints under Article 3, Article 5 §§ 1, 4 and 5 and Article 13 of the Convention and to declare the remainder of the application inadmissible; the parties’ observations; Having deliberated in private on 13 May 2025, Delivers the following judgment, which was adopted on that date: INTRODUCTION 1.     The application concerns the compulsory psychiatric treatment of the applicant in a high-security psychiatric hospital pursuant to an order issued by a criminal court, and his inability to initiate court proceedings to review the lawfulness of his continued confinement, which, along with the material conditions, allegedly amounted to ill ‑ treatment. The applicant relied on Articles   3, 5 and 13 of the Convention. THE FACTS 2.     The applicant was born in 1980 and lives in Kamyanske. The applicant was represented by Mr D.Y.   Zharyy, a lawyer practising in Dnipro. 3.     The Government were represented by their Agent, Ms   M.   Sokorenko, from the Ministry of Justice. 4.     The facts of the case may be summarised as follows. I.         The applicant’s placement in a Psychiatric Hospital and his DISCHARGE 5.     On 15 December 2011 the applicant was apprehended by the police at the home of an acquaintance. He was found in a state of severe emotional distress and alcohol intoxication, covered in blood and with physical injuries. A criminal investigation in respect of the attempted murder of his acquaintance was opened, with the applicant as a suspect. He was later committed to stand trial for this offence. 6 .     During the investigation, taking into account the applicant’s condition when the police found him at the scene of the crime and his claim not to remember the events in question, an in-patient forensic psychiatric examination was conducted by a commission of experts at the Dnipropetrovsk Regional Psychiatric Hospital. The Commission presented its conclusions in report no. 90, dated 22 March 2012, as follows: “Reasoning part: On the basis of the foregoing, the commission concludes that the applicant has not previously suffered from – [and] nor does he currently suffer from – any mental illness. The present psychiatric condition of [the applicant] is such that he is aware of and can control his actions (or inactivity) and can participate in the court hearing. A retrospective analysis of the applicant’s mental state at the time of the criminal act – in conjunction with the case material and the results of the present clinical psychiatric examination – allows for the conclusion that at the time of the act in question [the applicant] was in a state of temporary mental disorder (classified as an exceptional condition) in the form of a twilight state of consciousness. This is evidenced by the emergence – against the backdrop of existing organic pathology (previous head injuries, episodes of loss of consciousness) and exogenous intoxication – of: affective tension, anxiety [and] anticipation of trouble (which preoccupied almost all of his thoughts); delirious ideas that he was entitled to special status ( бредовые идеи своего особого значения) ; attitudes [consistent] with the imminent development of an acute psychotic state, characterised by disturbed consciousness [combined] with chaotic, impulsive [and] automatic actions ( импульсивными, автоматическими действиями ); ... the applicant’s ability to engage in basic orientation; and superficial interaction with those around him. The aforementioned temporary mental disorder deprived [the applicant] of the ability to understand and control his actions at the time of the act in question. Article 19 paragraph 2 of the Criminal Code is applicable. The [applicant’s] mental condition requires the application of compulsory measures of a medical nature. Conclusions: 1.     [The applicant] has not previously suffered from – [and] nor does he currently suffer from – any mental illness. The present psychiatric condition of [the applicant] is such that he is aware of and can control his actions (or inactivity) and can participate in the court hearing. 2.     During the period of time relating to the act in question, [the applicant] was in a state of temporary mental disorder in the form of a twilight state of consciousness, which deprived him of the ability to give an account of his actions (or inactivity) and to control them. 3.     It is recommended a compulsory measure of medical nature be applied [to the applicant] in the form of hospitalisation in a psychiatric hospital with an ordinary supervision regime.” 7 .     On 9 October 2012, relying on the above-mentioned report, the Dniprovskyi District Court of Dniprodzerzhynsk found that the applicant had committed the offence of attempted murder but that he should be exempted from criminal responsibility on the basis of his mental condition at the time of the offence. It ordered the applicant’s compulsory medical treatment in a high-security psychiatric hospital, in accordance with Article 94-5 of the Criminal Code. In doing so, the court noted that, although according to the experts, the applicant had not been suffering from any mental illness prior to the crime and was currently mentally healthy, the circumstances and nature of the offence, the sudden onset of the applicant’s twilight state during the crime, and the lack of any definitive evidence that that condition would never recur rendered him particularly dangerous to others. This decision was not appealed against, and thus became final. 8.     According to the applicant, he did not feel the need to lodge an appeal at the time because the forensic psychiatric report had clearly stated that he was mentally healthy. He therefore believed that if hospitalisation was considered necessary, it would only be a short-term measure. He could not have anticipated that the hospital would “convert” him into a mentally ill person and refuse to release him within six months. He was also unaware of the risk of potential mistreatment at the hands of the medical staff and the conditions in which patients were kept at the facility. By the time he was admitted to the hospital and realised the gravity of his situation – two months after the criminal court’s decision of 9 October 2012 – it was too late to lodge an appeal. 9.     On 6   December 2012 the applicant was transferred from a detention facility to the National High Security Psychiatric Hospital in Dnipro (“the Dnipro hospital”), a State-run institution. 10 .     On 11 March 2013 the medical consultation board of the Dnipro hospital examined the applicant with a view to “clarifying his diagnosis”. Following the examination he was diagnosed with organic personality disorder. The relevant part of the examination report, to the extent that it is legible, reads as follows: “.... From the moment of his admission to the hospital to the present day, the patient’s mental state has [been characterised by] emotional lability. He exhibits egocentricity, [with] an over-high regard for himself, and a ... sense of distancing [himself from others] [ сглаженное чувство дистанции ] . Eccentric [ Ексцентричен ]. Fixated on his somatic condition. He demanded special treatment as a citizen of two States, spoke of his intention to complain to the Israeli embassy. ... Regarding the crime he committed, he claims that something may have been put into his beer – possibly clonidine. ... He considers himself mentally healthy and not in need of treatment. ... He perceives the treatment as a punishment and evidence of a biased attitude towards him. He has incited other patients to disobey the regime, has associated with rule-breakers, and has been found in possession of prohibited items. He has defied the instructions of the medical staff, is angry and [displays] a negative [attitude]. His thinking has elements of circumstantiality. The experimental-psychological examination [ эксперементально ‑ психологическое исследование ] revealed “... (against a backdrop of anxiety and tension) mild disorders of both organic origin (some absent-mindedness, attention fluctuations, reduced speed in acquiring new skills, slow mental processes, forgetfulness, and increased fatigue by the end of the examination) and of an endogenous nature (reduced critical thinking, pedantic judgments, a tendency to focus on weak signs [ тенденции к использованию слабых признаков ], and impaired goal ‑ directed behaviour). In the emotional-volitional sphere – rigidity, overconfidence, inconsistency of moral values, inflated self-esteem, impulsive actions, a tendency to antisocial behaviour, sensitivity to criticism, and irritability and selectivity in interpersonal contacts were observed. No paroxysms were observed. Received treatment: ... Tizercine 150 milligrams per day. ... Mental status: The patient is amenable to contact, correctly oriented, and carries himself with a sense of dignity, displaying courtesy. He strives to present himself in the best light. He provides detailed and thorough information about his medical history, paying particular attention to head injuries and headaches. His thinking is circumstantial, and he exhibits rigidity [of thinking and behaviour]. Attention is adequately concentrated and maintained, and he easily shifts to abstract topics, showing an inclination towards lofty discussions on morality and justice. His intellectual capacity corresponds to his educational background and life experience. Memory is intact in respect of past and present events but impaired regarding the time of the offence [committed by him]. Emotionally unstable. No signs of psychotic symptoms are present. He does not consider himself mentally ill and denies the need for treatment. He does not critically assess his current situation. Conclusion of the panel: Taking into account the patient’s history of head injuries and periods of alcohol abuse, as well as clinical examination data (the presence of cognitive dysfunction and emotional-volitional changes, [and] scattered residual neurological symptoms) and EEG data, the patient can be given the principal psychiatric diagnosis: organic personality disorder (organic pseudopsychotic personality). Experienced a twilight state of consciousness (15 December 2011), F 07.0.” 11 .     On 5 April and 1 October 2013 and on 25 March 2014 the panel of Dnipro hospital specialists (including those who signed the conclusion of 11   March 2013) examined the applicant with a view to deciding on whether there was a need for further compulsory treatment. Each time the panel noted that the emotional and volitional instability of the applicant, and his irritability and anger – together with the egocentric rigidity of his beliefs and attitudes, his denial of guilt for the socially dangerous act that he had committed, his lack of understanding of the need for treatment, and his failure to recognise the presence of mental disorders – determined the clinical picture of his disease and rendered him particularly dangerous to society. The panel concluded that the applicant’s compulsory medical treatment in a high ‑ security hospital should be continued. 12 .     On 16 April, 24 October 2013 and 25 April 2014, the Krasnogvardiiskyi District Court of Dnipropetrovsk (“the District Court”) accepted the panel’s recommendation and ruled accordingly in the presence of a prosecutor, a lawyer (apparently state-appointed, each time a different lawyer) and a representative of the Dnipro hospital. The relevant part of the decision of 16 April 2013 reads: “... By a decision of the Dniprovsky District Court of 9 October 2012, [the applicant] was committed to a psychiatric hospital under strict supervision for compulsory treatment ... The psychiatrist’s submission (to which the report of the panel of psychiatrists of 5   April 2013 is attached) states that [the applicant] suffers from an organic personality disorder and that, owing to his mental condition, he must continue to undergo compulsory treatment in a psychiatric hospital under strict supervision. Having discussed the application, heard the parties, and examined the case file, the Court considers that the application should be granted because [the applicant] suffers from a severe mental disorder and has committed acts that constitute an imminent danger to himself and others. In the light of the foregoing – and in accordance with Article 95 of the Criminal Code, Article 514 of the Criminal Procedure Code, and Articles 19 and 22 of the Psychiatric Assistance Act – the court has decided to continue the use of coercive measures of a medical nature ... in a psychiatric hospital under strict supervision. ...” The decision of 24 October 2013 reads as follows: “... By a decision of the Dniprovsky District Court of 9 October 2012, [the applicant] was committed to a psychiatric hospital under strict supervision for compulsory treatment ... The psychiatrist’s submission (to which the report of the panel of psychiatrists of 1   October 2013 No. 1575 is attached) states that [the applicant] suffers from an organic personality disorder (organic pseudopsychotic personality). He experienced a twilight state of consciousness on 15 December 2011 and, owing to his mental condition, he must continue to undergo compulsory treatment in a psychiatric hospital under strict supervision. Having discussed the application, heard the parties, and examined the case file, the court considers that the application should be allowed for the following reasons. It is clear from the conclusion of the psychiatric panel and the statements made by the [hospital’s] representative at the court hearing that the [applicant’s] mental state remains unstable, which indicates that [the applicant] remains a particular danger to others and that it is necessary to continue to apply to him coercive medical treatment in a psychiatric hospital under strict supervision. Therefore, taking into account the fact that [the applicant’s] state of health remains unstable – and given the seriousness of the socially dangerous act committed – the court concludes that it is necessary to continue his compulsory treatment in a psychiatric hospital under strict supervision, in accordance with the provisions of Article 94-5 of the Criminal Code. In the light of the foregoing – and in accordance with Articles 94 and 95 of the Criminal Code, Articles 19 and 22 of the Psychiatric Assistance Act, and Article 514 of the Criminal Procedure Code – the court has decided to continue the use of coercive measures of a medical nature ... in a psychiatric hospital under strict supervision. ...” The decision of 25 April 2014 reads: “... By a decision of the Dniprovsky District Court of 9 October 2012, [the applicant] was committed to a psychiatric hospital under strict supervision for compulsory treatment ... In the psychiatrist’s submission (to which the report of the panel of psychiatrists of 25 March 2014 is attached) states that [the applicant] suffers from an organic personality disorder and that, owing to his mental condition, he must continue to undergo compulsory treatment in a psychiatric hospital under strict supervision. Having discussed the application, heard the parties, and examined the case file, the court considers that the application should be granted for the following reasons. It is clear from the conclusions of the psychiatric panel and the statements made by the [hospital’s] representative at the court hearing that the [applicant’s] mental state remains unstable, which indicates that [the applicant] remains a particular danger to others and that it is necessary to continue to apply coercive medical measures treatment in a psychiatric hospital under strict supervision. Therefore, taking into account that [the applicant’s] state of health remains unstable and given the seriousness of the socially dangerous act committed, the court concludes that [the applicant] requires continued compulsory treatment in a psychiatric hospital under strict supervision, in accordance with the provisions of Article 94-5 of the Criminal Code. In the light of the foregoing – and in accordance with Articles 94 and 95 of the Criminal Code, Articles 19 and 22 of the Psychiatric Assistance Act, and Article 514 of the Criminal Procedure Code – the court has decided to continue the use of coercive measures of a medical nature ... in a psychiatric hospital under strict supervision. ...” 13.     The applicant did not attend any of the court hearings; each time he signed a pre-typed request for the case to be considered in his absence. According to him, he – like other patients – had been forbidden by the Dnipro hospital administration to attend the court hearings and had been forced to sign waivers of his right to participate. 14 .     On 18 September 2014 the panel of psychiatrists from the Dnipro hospital again decided (on the same grounds as on the previous occasions) that the applicant’s compulsory psychiatric treatment should be continued, since no changes had been observed in the applicant’s condition. The Dnipro hospital requested the District Court to rule accordingly. 15.     On 29 September 2014   the applicant signed a legal aid agreement with a private lawyer, S., engaged by his mother. 16.     On 8 October 2014, apparently during a meeting with S., the applicant lodged a request with the District Court to be allowed to attend the forthcoming hearing in which the issue of his continued medical confinement would be considered. On the same day, S. submitted a copy of the applicant’s request to the Dnipro hospital administration and requested that the applicant be brought to the District Court on 13 October 2014. The request was granted. According to the applicant, all this had only been possible thanks to the support of the Ombudsperson; he did not provide any details in this regard. 17 .     On 13 October 2014, in the applicant’s presence, the District Court refused the Dnipro hospital’s request for the continued application of coercive medical measures (see paragraph 14 above). The relevant part of the decision reads as follows: “... The psychiatrist’s submission (to which the report of the panel of psychiatrists of 18 September 2014 No. 1355 is attached) states that [the applicant] suffers from an organic personality disorder and that, owing to his mental condition, he must continue to undergo compulsory treatment in a psychiatric hospital under strict supervision. At the court hearing, the prosecutor, the lawyers and [the applicant] considered that the psychiatrist’s application should be rejected. Having discussed the application, heard the parties, and examined the case file, the court considers that the psychiatrist application should be rejected for the following reasons: ... The forensic report of 22 March 2012 regarding the applicant’s inpatient psychiatric examination stated that [the applicant] had never suffered and was not suffering from any psychiatric illness. ... It was recommended that a compulsory measure of medical nature be applied [to the applicant] in the form of hospitalisation in a psychiatric hospital with ordinary supervision regime. However, ... he was placed into a high ‑ security psychiatric facility. ... It was established at the court hearing that [the applicant] has been held in the high ‑ security psychiatric hospital since December 2012. [The applicant] was diagnosed with “organic personality disorder” (organic pseudopathic personality). Experienced twilight state of consciousness on 15 December 2011. It appears from the psychiatrist’s submissions that [the applicant] experienced the twilight state of consciousness only once (on 15 December 2011) since this disorder is of a short-term nature and in [the applicant’s] case was caused by alcohol intoxication. During his stay in [the Dnipro hospital] the applicant did not experience a recurrence of that mental condition. According to the psychiatrist’s submission, it can be assumed that under the influence of alcohol, the [same] personality disorder may recur. However, the court cannot take into account the psychiatrist’s assumption that the applicant could suffer a recurrence of the disease under the influence of alcohol in the future. Paragraph 25 of the report of the panel of psychiatrists of 18 September 2014 attests that the applicant did not manifest any perceptual disorders or delusions during his stay in the hospital (for more than two years). In addition, the court has established that [the applicant] has [voluntarily] taken part in refurbishment works [at the Dnipro hospital], and participates in group therapy in order to develop the right attitude to his condition and to consolidate socially acceptable stereotypes of behaviour. Furthermore, during the court hearing [the applicant] behaved calmly, and adequately answered the questions. Taking into account the fact that the applicant has suffered from twilight personality disorder only once (on 15 December 2011, under the influence of alcohol), and that he has not experienced any further relapses or exacerbation of his mental state, and given also that the applicant has not displayed any aggressive behaviour, perceptual disorders or delusions, the court has concluded that the psychiatrist’s request should be refused. ...” 18.     The applicant’s treating doctor lodged an appeal against the decision of 13 October 2014, stating, inter alia , that the domestic court did not have any specific knowledge of psychiatry enabling it to assess the applicant’s mental condition and had therefore acted ultra vires when refusing the hospital’s request. The doctor observed that the applicant’s behaviour during the hearing could well have stemmed from his belief that he was not ill. 19.     On 24 October 2014 the Dnipropetrovsk Regional Court of Appeal (“the Court of Appeal”) returned the appeal to the hospital, noting that it had been lodged by an inappropriate party (namely, by the psychiatrist instead of the head of the Dnipro hospital). Accordingly, the decision of 13 October 2014 became final on the same day. 20.     Also on the same day (24 October 2014) S. and the applicant’s mother requested the Dnipro hospital (both orally and in writing) to release the applicant. After the Dnipro hospital director refused to do so (noting that there was no court decision ordering the applicant’s discharge), the applicant’s mother and his lawyer complained to the Ombudsperson’s Office. 21 .     On 28 October 2014 the Dnipro hospital psychiatric panel conducted another examination of the applicant and concluded that he required continued psychiatric treatment – but under enhanced supervision (rather than the high-security regime that had applied until then). The panel requested the District Court to order that such supervision be imposed. 22 .     On the same day, upon the written instruction of a prosecutor (apparently given after an intervention by the Ombudsperson), the applicant was discharged from the Dnipro hospital. Pending his release, the applicant was required to continue taking neuroleptics. Before being discharged from the hospital, he signed a written statement to the effect that he had no complaints against the Dnipro hospital with regard to his medical treatment and the conditions of his stay. According to the applicant, he had no choice but to sign this document in order to be discharged. 23.     On 14 November 2014 the District Court refused the Dnipro hospital’s request of 28 October 2014 for a change of the compulsory medical measures (see paragraph 21 above) on the same grounds as those that it had given on 13   October 2014. That decision was final. 24 .     In her interview to a newspaper, released on 2 December 2014, the Ombudsperson stated the following: “[The applicant] is the only patient of the [Dnipro hospital] who has been released so far. The fact is that, pursuant to an order issued by the Ministry of Health, after the medical examination that patients undergo every six months, there are only two options: to remain in the psychiatric hospital that follows this regime or to be transferred to a similar institution that follows another regime. No third option exists. No one – neither doctors nor judges – cares: maybe the patient was cured in the first three months, and it is no longer necessary to keep him in this medical institution for six months. In our country, a patient cannot apply to a court for an early medical commission [hearing] or ask for an independent opinion ... not to mention the fact that, according to established practice, patients are usually not present in court. I have the right to visit psychiatric hospitals without [giving] advance notice. So, when I travelled to visit [the Dnipro hospital], I also attended a court hearing [concerning a different case] headed by the judge who [later] considered [the applicant’s] case. We had a long discussion. The judge explained that he was not an expert in psychiatry and could not decide whether a [certain course of] treatment should be prolonged or not. He said there were doctors for that. I argued: “You have a document on your desk – a statement from the psychiatric hospital that it is necessary to continue the treatment of a woman who “poses a great danger to society”. What can you understand from this document, honourable judge? Nothing at all. Meanwhile, if you had bothered to invite the patient to court, you would have known that this “woman [who is] dangerous to society” was an 85-year-old bedridden, blind and almost deaf woman”. After our conversation, the judge became thoughtful. And it was thanks to that [meeting with the judge] that [the applicant] was eventually able to attend the hearing at which his future fate was decided. A visit to the [Dnipro hospital] left me with a depressing impression. Instead of people in white coats, we were met by real prison guards – in uniform, with batons and handcuffs on their belts. The dormitories did not provide the slightest personal space to patients. There were no bedside tables with photos of loved ones or books on them. The distance between beds was about twenty centimetres. You can’t even put your feet down. How can one recover in such an atmosphere? It seems to me that this hospital (which existed under the NKVD in Soviet times) is a remnant of the [old] healthcare system and is not designed to cure patients at all. All the patients I have seen there are in a lethargic somnambulistic state. And the conditions in which they live appalled me. Even the women wear the same nightgown day and night – for walking, for eating and for sleeping. They are allowed to wash themselves and change their shirts once a week! Only relatives are allowed to visit patients – and only on weekdays, during working hours. It is not clear why. ... In general, in my opinion, all conditions have been created in that hospital [to ensure] that people never recover and never leave. No wonder many people die there. After looking around this institution, we gathered in the office of the head doctor, made our comments and recommendations to him and sent them in writing to the Ministry of Health. The Ministry, instead of taking action, sent this document back to the head doctor, who replied to us that our comments were untrue. That was the end of it. However, we have other means of [exerting] influence. [I will do] as much as I can ... to solve this problem and help the patients – just as I helped [the applicant] (with the assistance of the Dnipropetrovsk regional prosecutor’s office).” II.       Medical treatment and Material conditions A.    Medical treatment 1.      The applicant’s medical file 25.     The applicant’s medical file – the full copy of which has been provided to the Court by the applicant – sets out (day by day) the care and treatment received by the applicant from 6 December 2012 until 28   October 2014. It contains records made by the attending psychiatrist during his daily visits to the applicant, documents concerning the general medical care and specialised care administered to the applicant. 26.     The daily notes of the attending psychiatrist reveal that throughout his hospital stay, the applicant was consistently well-oriented and did not experience delusions, hallucinations, or anxiety. He showed no signs of aggression, self-harm, or psychosis. Generally, he remained calm, avoided creating conflicts, and adhered to the hospital regime. No considerable changes in his condition are apparent from his medical documents. 27 .     The records further indicate that the applicant’s attitude was consistently negative towards his hospitalisation and treatment. On a daily basis he insisted that he was mentally healthy, objected to the administration of neuroleptics, and asserted that the treatment constituted an assault and a means of humiliating and punishing him for his “fight for justice”. He vowed to raise his grievances about his treatment and detention conditions with a lawyer, influential acquaintances, and consular institutions (citing his alleged dual citizenship). On several occasions, he complained to the attending psychiatrist that his lawyer had not defended him in court and had failed to respond to his enquiries. 28.     According to his admission record of 6 December 2012, the applicant was admitted to the Dnipro hospital with “twilight state of consciousness (resolved)” as his “diagnosis”. During the initial medical examination carried out on the day of his admission, the applicant behaved appropriately and maintained that he was mentally healthy, with the duty psychiatrist noting no symptoms of any mental disorder and prescribing no treatment. On the same date the applicant gave written consent to the processing of his personal data and to an HIV test being performed on him. 29 .     On 7 December 2012 a “rehabilitation-therapeutic” plan for the first, “adaptation-diagnostic” stage of the applicant’s treatment was drawn up. It appears to be a standard template document, with the applicant’s name and diagnosis – “resolved twilight state” – manually entered, by pen. The plan included, among other things, the requirement to establish and justify the main clinical diagnosis within ten days and to record it in accordance with the World Health Organization’s International Statistical Classification system of Diseases and Related Health Problems. It also provided in general term for the treatment of the primary psychopathological symptoms (which could include, for example, anti-psychotic therapy, general strengthening therapy, vitamin therapy). Additionally, psychotherapeutic activities, explanations to the patient regarding the purpose of hospitalisation, his rights, and the conditions of the detention regime were noted in the plan. The length of time for which it was intended that the treatment plan would last was not specified, but it was indicated that once all the measures outlined in the plan had been implemented, it would be necessary to move on to the second stage. 30.     The psychiatrist notes dated 10 December 2012 cited a letter from the applicant to his mother in which he asserted his innocence. The psychiatrist further noted that “an individual talk was held with the applicant, during which were explained the reasons for and aim of his placement in the psychiatric facilities, his rights, detention regime and daily schedule, as well the necessity of the prescribed treatment and its potential side effects”. 31.     On 13 December 2012 the treating psychiatrist indicated that the main clinical diagnosis was one of a resolved twilight state of consciousness ( разрешившееся сумеречное расстройство личности ). This was amended on 11 March 2013 to include organic personality disorder as the principal disease (see paragraph 10 above). 32.     From 14 December 2012 the applicant was given neuroleptic medication; he continued with that treatment until his discharge from the Dnipro hospital on 28 October 2014. According to the medical records, the applicant was administered Aminazin (chlorpromazine), Tizercine (levopromazine) and Sonapax (thioridazine) in various dosages and forms. 33.     The first prescription of neuroleptic medication (Aminazin) was made by the applicant’s attending psychiatrist because the applicant “requested a meeting, during which he expressed irritation and dissatisfaction with the detention conditions and the behaviour of other patients.” The prescribed dosage was 25 milligrams twice daily, with no specified duration. Within a few days it was noted that the applicant had become calm and ceased expressing dissatisfaction, now that he was under the influence of Aminazin. However, he was described as arrogant and unconstructive. 34.     On 19 December 2012 the applicant was transferred from the admissions unit to the treating department. The transfer report noted that during his stay in the admissions unit the applicant was responsive to contact, logical, coherent, and showed no signs of psychosis, although his emotional reactions were labile, and his critical faculties were impaired. A resolved twilight state of consciousness was indicated again as the diagnosis. 35.     A medical examination of the applicant in the treating department recorded that the applicant insisted that he was mentally healthy and questioned the reasons for his hospitalisation (asking many questions about the prospects of his hospitalisation and its timing). He contended that he did not know why the forensic experts had decided that he needed to be hospitalised. He was described as polite, without delusions or hallucinations, but in a low mood due to his situation. The diagnosis was that of a “twilight state of consciousness, completely dissipated.” The doctor indicated that given the anxiety and emotional lability expressed by the applicant it was necessary to sedate him. Aminazin at a reduced dose (25 milligrams per day) was prescribed, with no specified duration. 36.     On 25 December 2012, after the applicant refused to shower (alleging that it was too cold in the premises), the dosage of Aminazin was increased to 75 milligrams per day, owing to what was described as his affective reactions, negativism, and protest behaviour. 37.     On 14 January 2013 the attending physician switched the applicant’s treatment from Aminazin tablets to Tizercine injections, administered three times per day for an unspecified duration. This change was explained by the applicant’s negative attitude towards the therapy, daily challenges to the necessity of the treatment, alleged hiding of prohibited items, incitement of another patient to disobey the hospital regime, confrontational behaviour towards hospital staff (whom he accused of unfair and biased treatment), and overall resistance to correction. 38.     On 21 January 2013, the applicant was seen by the Dnipro hospital’s chief psychiatrist, who observed that the applicant had been calm, had been asleep for almost the entirety of the preceding days, and had adhered to the detention regime. The examination revealed that the applicant was communicative and accurately aware of time, place, and his own identity, with no impairment of intelligence or memory. He did not display any anger but rather tended to engage in discussions about morality and justice, insisted on his innocence, and maintained a negative attitude towards his hospitalisation and treatment, asserting that he was mentally healthy and did not require the neuroleptic treatment. The chief psychiatrist ordered the continuation of sedative treatment with Tizercine, but switched the delivery method of that treatment from injections to tablets (150 milligrams per day). 39.     On 5 April 2013, the applicant’s treating psychiatrist approved a rehabilitation-therapeutic plan for the second stage, focusing on intensive therapeutic and rehabilitation measures. The plan referred to the diagnosis established on 13 December 2012 and authorised the use of neuroleptic – medications that do not induce epileptic seizures – specifically Tizercine, Ridazin (thioridazine), Aminazin and Clopixol (zuclopenthixol). The declared objective was to compensate for any emotional-volitional disorders and to prevent the progression of personality changes. Additionally, the plan prescribed psycho-corrective activities aimed at fostering the applicant’s awareness of his illness and its alcohol-related nature, promoting anti-alcohol attitudes, and emphasising the need for treatment. It also included therapeutic labour activities. 40.     In December 2013, Tizercine was replaced with Sonapax (75   milligrams per day), but that was switched back to Tizercine (75   milligrams per day) in August 2014. In extending the treatment the attending psychiatrist mainly cited the applicant’s negativistic attitude towards his hospitalisation and treatment, reluctance to receive treatment, irritability and persistence in defending his point of view, lack of critical insight into his mental illness and the actions he had committed, his expression of dissatisfaction with regime issues, rapid mood changes and egocentric behaviour. 41.     The applicant’s medical file contains no records suggesting that the administration of neuroleptics had resulted in any serious side effects, although it is apparent that it caused the applicant to feel sleepy and weak and had to be supplemented (following the applicant’s complaints) with analeptic and heart medication. 42.     According to the medical file, during his hospital stay the applicant also participated in group social training sessions and some psychological and pedagogical activities. 2.      The applicant’s submissions 43.     According to the applicant, in March 2013, Dnipro hospital practitioners had deliberately changed the forensic expert’s standing diagnosis (which had declared him mentally healthy), and had instead misdiagnosed him with a mental illness in order to prolong his stay in the hospital as a form of imprisonment for the crime that he had allegedly committed. After his admission to the Dnipro hospital, the hospital staff had refused to inform him about his treatment plan, arguing that such information should not be shared with patients. They had also unsuccessfully urged him to apply for a disability allowance, which would then be at their disposal. 44 .     The applicant contended that shortly