CEDH · CASELAW;JUDGMENTS;CHAMBER;ENG — 31 mars 2026

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margin-bottom:12pt; text-indent:14.2pt; text-align:justify; page-break-inside:avoid; page-break-after:avoid } .s69DCC830 { margin-top:36pt; margin-bottom:0pt } .sD95767A9 { width:33.22pt; font-family:Arial; display:inline-block } .s11485D2C { width:148.09pt; font-family:Arial; display:inline-block } .s1E019DFF { width:46.56pt; font-family:Arial; display:inline-block } .sA49AD2E4 { width:177.11pt; font-family:Arial; display:inline-block } .fixListIndent { list-style-position: inside }   FOURTH SECTION CASE OF MAKKI v. DENMARK (Application no. 10297/23)     JUDGMENT Art 3 (substantive) • Inhuman and degrading treatment • Prolongation of the restraint of the applicant, suffering from paranoid schizophrenia, to his bed for 11   days and 11   hours in a psychiatric hospital, after assaulting a nurse, pending his transfer to a high security facility • Delay did not sit well with the relevant European and national standards nor was it in accord with the Danish legislators’ aim to reduce the use of compulsory restraint in general • Not sufficiently proven that the prolongation of the restraint measure, given its duration, was strictly necessary, respected the applicant’s human dignity and did not expose him to pain and suffering   Prepared by the Registry. Does not bind the Court.   STRASBOURG 31 March 2026   This judgment will become final in the circumstances set out in Article 44 § 2 of the Convention. It may be subject to editorial revision. In the case of Makki v. Denmark, The European Court of Human Rights (Fourth Section), sitting as a Chamber composed of:   Lado Chanturia , President ,   Jolien Schukking,   Faris Vehabović,   Ana Maria Guerra Martins,   Anne Louise Bormann,   Sebastian Răduleţu,   András Jakab , judges , and Hasan Bakırcı, Section Registrar, Having regard to: the application (no.   10297/23) against the Kingdom of Denmark lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Danish national, Mr Abdeelhadi Abbas Makki (“the applicant”), on 21   February 2023; the decision to give notice to the Danish Government (“the Government”) of the application; the observations submitted by the respondent Government and the observations in reply submitted by the applicant; the comments submitted by the non-governmental organisations Dignity – Danish Institute against Torture, and the Danish Institute for Human Rights , which were granted leave to intervene by the President as third-party interveners in the proceedings (Article 36 §   2 of the Convention and Rule   44 §   3 of the Rules of Court); Having deliberated in private on 10 February and 10 March 2026, Delivers the following judgment, which was adopted on that last-mentioned date: INTRODUCTION 1.     The applicant suffers from paranoid schizophrenia. After being admitted to a psychiatric hospital he assaulted a nurse there and was strapped to a restraint bed from 1.30 p.m. on 3 June 2016 to 8.18 p.m. on 16   June 2016. He complains that that measure, from 9.30 a.m. on 5 June 2016 onwards, was in breach of Article 3 of the Convention. THE FACTS 2.     The applicant was born in 1995 and lives in Slagelse. He was represented by Mr Tobias Stadarfeld Jensen, a lawyer practising in Aarhus. 3.     The Government were represented by their Agent, Ms   Vibeke Pasternak Jørgensen, of the Ministry of Foreign Affairs, and their co-Agent, Ms   Nina Holst-Christensen, of the Ministry of Justice. 4.     The facts of the case may be summarised as follows. 5.     The applicant suffers from schizophrenia and a mild intellectual disability. He was admitted to a psychiatric hospital several times (voluntarily and involuntarily) in 2015 and 2016, including on 10 May 2016 owing to an incident in which he used violence against a family member. 6.     After being discharged, he was involuntarily readmitted to a psychiatric hospital on 3 June 2016. There he assaulted a nurse by putting an arm around the nurse’s neck and stabbing him in the back of the head and the upper back nine times with a fork. 7 .     Consequently, at 1.30 p.m. the applicant was strapped to a restraint bed with a belt and foot and wrist straps. He remained strapped to the bed until 8.18   p.m. on 16 June 2016, when the measure was formally lifted in order to transfer the applicant first to the Department of Forensic Psychiatry at Middelfart Hospital and thereafter, on 28 February 2019 to the High-Security Psychiatric Unit ( Sikringsafdelingen ). 8.     While restrained, however, one or other of the straps were sometimes removed for certain periods. Moreover, once a day for about thirty minutes the applicant was released, with the assistance of the police, to shower, go outdoors and smoke. He was under the constant observation of medical staff and was attended to several times per day by psychiatrists, who reviewed the justification for his being physically restrained in the light of the statutory requirements set out in the Mental Health Act. 9 .     On 9 June 2016 the chief psychiatrist responsible for the applicant’s care applied for a so-called “dangerousness decree” ( farligheds-dekret ) (see paragraph   24 below). It was issued on 23 March 2018 by the Ministry of Justice and approved by a court on 21 August 2018. Under a dangerousness decree, extraordinarily dangerous persons who are mentally ill and who constantly pose a serious and imminent danger to the life or body of others, where less intrusive measures are insufficient, must be placed at the High ‑ Security Psychiatric Unit, the only institution of its kind in Denmark. The applicant was placed there on 28   February 2019. 10 .     On 5 March 2019, the applicant complained to the Psychiatric Patients’ Complaints Board ( Det Psykiatriske Patientnævn ) about his having been physically restrained from 3   June to 16   June 2016. In a decision of 20   May 2019, the Board found in his favour in part. It found that the use of physical restraints from 1.30 p.m. on 3 June until 9.30 a.m. on 5 June 2016 had been lawful whereas the measure’s continuation from 9.30 a.m. on 5 June to 8.18   p.m. on 16 June 2016 had been unlawful. In respect of the latter period, the Board assessed that the imposition of restraints had lasted for longer than necessary in that the authorities had failed to substantiate that there had been a specific, present and demonstrable risk that the applicant had been a danger to others. The Board also expressed concern regarding the fact that the mandatory medical assessment after 48 hours, which occurred on 5   June 2016, had not been performed by an external psychiatrist but by B.J., the chief psychiatrist responsible for the applicant’s care, and that on several occasions the time span from one medical assessment to the next had been around twelve hours or more, which was not in accordance with section 21 of the Mental Health Act. 11.     By virtue of section 37 of the Mental Health Act (see paragraph   42 below) the case was brought before the District Court ( Retten i Næstved ) against the Region of Southern Denmark. The applicant claimed damages for a violation of Article 3 of the Convention due to his restraint from 9.30   a.m. on 5 June 2016 to 8.18 p.m. on 16 June 2016. 12.     The applicant’s daily medical records were submitted to the District Court. In so far as relevant, they included the following quotations or events. 13.     At 3.16 p.m. on 3 June 2016 the applicant was described by a nurse as being “awake and offer[ing] relevant answers when questioned”. He asked if the nurse he had stabbed was all right and he apologised multiple times for his behaviour. 14 .     At 9.48 p.m. on 3 June 2016 a nurse wrote, among other things: “... As agreed with Chief Psychiatrist B.J., [the applicant] must remain restrained with a belt over the weekend here at P1 Ward or, if [he] is deemed sufficiently calm tomorrow to [be released from the restraints], he must be referred to Odense University Hospital (OUH) while [still being] restrained with a belt, which can only be removed after his arrival [there]. OUH refuses to accept [the applicant] if he still needs to be restrained with a belt.” 15.     At 10.34 p.m. on 3 June 2016 a nurse wrote, inter alia : “... [the applicant] remains restrained with a belt until tomorrow... All through the evening the straps are changed, so that [the applicant] has a foot or a hand free from the stap at all times ... that is by agreement with Chief Psychiatrist B.J., and K., the first doctor on call. [The applicant] cooperated ... [with the straps being changed] ... [but he] becomes slightly irritated when the conversation touches on his brother. Otherwise, friendly and cooperative ...” 16.     At 12 noon on 4 June 2016 a nurse wrote: “... [one of the] wrist strap[s] changed at 8.10 a.m. (the left one is the one released now). When I try to tighten the right wrist strap, [the applicant] lashes out at me. Severely reprimanded and cooperates afterwards. ... H[e h]as been assessed by J.B., the second doctor on call. Please refer to her note. [The applicant] to stay restrained using three straps until ... an assessment tomorrow.” 17.     At 9.30 a.m. on 5 June 2016 B.J. wrote: “[When there is contact with] the patient, [he] shouts that he promises not to do anything to anybody; [he] believes that the reason for his attack on a member of staff was self-defence. Promises me to stay calm. However, the patient becomes irascible again as soon as I leave the room; it is difficult to control his behaviour [and] the patient is deemed to still pose a risk to others ... therefore mechanical restraint with two foot straps and one wrist strap is [being] continued. ... The patient prefers to talk about himself as being blameless for the assault of the staff member; he still believes that it was self-defence. He also asserts that he is now quiet and calm and that he will not do anything. I point out to the patient that he was also quiet and calm on the day when he arrived from Bispebjerg Hospital and that the assault occurred without any warning, and that for that reason we are concerned about his violent behaviour.” 18 .     At 1.22 p.m. on 5 June 2016 B.J., who carried out the 48   hours mandatory medical assessment – which, as found by the Board (see paragraph   10 above), should have been carried out by an external psychiatrist – wrote: “[He i]s still dissatisfied about being restrained with a belt, has just been angry and has made verbal threats. Continues to believe that he is at no fault in the incident. Promises never again to do anything to anybody, but as soon as I leave the room the patient starts testing limits and becomes irascible again ... Awake, alert and orientated – apparently friendly and smiling. But only towards me, irascible towards other staff members. Self-possessed and [speaking] pertinently, pronounced externalizing behaviour. Apparently, no productive symptoms, but [was] observed mumbling to himself [and] having paranoid delusions that there is something in the cookies. The patient is deemed to still pose a risk to others and therefore mechanical restraint with a belt, a foot strap and a wrist strap, which are alternated every hour, is continued.” 19 .     At 10.30 a.m. on 6 June 2016 B.J. wrote, inter alia : “ The patient lies calmly in his bed [and] would like to be relieved of the restraints, however, so far it has been difficult to make any agreement with him in this respect. The patient is told that we are struggling very hard to find a solution for him to be released [from the restraints] but that I am unable to release him now because he has been so dangerous.” 20.     At 1.00 p.m. on 7 June 2016 the chief psychiatrist of another hospital, C.BP., whose role it was to provide an external, second opinion of the mechanical restraint, wrote: “Conclusion and plan: ... ‘It is therefore my assessment that the patient must still be deemed to be seriously mentally ill and dangerous to those around him, and in the current situation I see no other option but to keep the patient mechanically restrained while allowing him some degree of freedom in the presence of police officers.’” 21 .     Starting on 7 June 2016 the police came once a day – at the request of B.J. – for around thirty minutes so that the applicant could be released in order to shower, smoke and get some fresh air. 22.     At 8.29 p.m. on 7 June 2016 the applicant threw a cup of coffee at the staff member tasked with constantly monitoring him and threatened to kill all the staff members with a knife. 23.     At 4.15 p.m. on 8 June 2016 the applicant was still considered seriously mentally ill and deemed to pose an immediate risk of harm to others, and he therefore remained mechanically restrained with a belt, one wrist strap and one foot strap. 24 .     On 9 June 2016 B.J. applied for a so-called “dangerousness decree” in order to have the applicant transferred to the High-Security Psychiatric Unit where extraordinarily dangerous persons are treated, in accordance with Chapter   11 of the Mental Health Act. 25 .     At 12.30 p.m. on 9 June 2016, C.BP., in the course of his weekly medical assessment, wrote: “Given the [circumstances], because we are waiting for the Ministry of Justice’s decision to issue a ‘dangerousness decree’ and since [the applicant] still is deemed to be dangerous to other people, I cannot see that anything can be done other than to have [the applicant] restrained. [The applicant] is released to the extent it is feasible, and when the police are present.” 26.     On 10 June 2016 the wrist straps were removed. The applicant was still restrained by one foot strap. After members of the applicant’s family visited him, he became extremely threatening towards the staff member tasked with constantly monitoring him, whom the applicant threatened to stab. 27.     On 12 June 2016 the applicant flung his bedside table, chair and mug towards the corridor, with the aim of hitting staff member monitoring him. The applicant also threatened to kill her. The police were called, and a wrist strap was applied. His foot and wrist straps were subsequently alternated regularly. 28 .     From 14 June 2016 wrist straps were no longer use d. The applicant continued to be mechanically restrained with a belt and a foot strap. 29 .     By a judgment of 3 September 2019, the District Court found against the applicant for the following reasons: “The European Court of Human Rights has found several times that the mechanical restraint of psychiatric patients is contrary to Article 3 of the European Convention on Human Rights, which says that no one shall be subjected to torture, nor to inhuman or degrading treatment or punishment. The purpose of the 2015 amendment to the Mental Health Act and thus the tightening of the rules on the use of mechanical restraint in section   14 of the Act was to reduce the use of mechanical restraint. Accordingly, considerations for the protection of patients prevail when determining whether it is possible in any case to apply mechanical restraint within the scope of the Convention. The European Court of Human Rights has also said that mechanical restraint may be used only as a last resort to avoid a risk of injury to a patient or others, that mechanical restraint may not be applied for longer than strictly necessary, and that mechanical restraint may not in any circumstances be justified by a lack of staff. It follows from section 14(2)(i) and section 14(3) of the Mental Health Act that the application of mechanical restraint requires that there is an imminent risk to the body or health of a patient or others and that the maximum period of mechanical restraint is a few hours unless [a longer period is] justified having regard to the life, health or safety of the patient or others. According to the case file, [the applicant] was mechanically restrained at 1.30   p.m. on 3   June 2016 after having, among other things, assaulted a staff member with a fork, with which he had stabbed the back of the head and upper back of that staff member several times. [The applicant] was mechanically restrained with the assistance of police officers. Those involved agreed that he was mechanically restrained in accordance with section 14(2)(i) of the Mental Health Act. The medical records describe [the applicant] during the subsequent period and until his transfer on 16 June 2016 to the Department of Forensic Psychiatry ... as constantly displaying swift changes in his mood from calm to threatening, as lacking awareness of his disease or having no realistic awareness of his own acts, whether immediately prior to or during the period of the mechanical restraint, and as displaying externalising behaviour against staff. Moreover, he also sometimes resisted [taking] medication. Throughout the entire period, [the applicant] was deemed to be mentally ill and a risk to others, which was the reason for continuing the mechanical restraint. The assessment was made by B.J., the treating chief psychiatrist, who had prior knowledge of [the applicant] and thus of his behaviour patterns and the validity of his utterances stating his intention to be cooperative. The assessment was approved by several other external psychiatric specialists who assessed [the applicant]. B.J., the chief psychiatrist, has stated that [the applicant] turned aggressive when his behaviour was controlled and when things did not go his way, that he lacked impulse control and had a low threshold for losing his temper, and that it was not possible to administer medication to alleviate the severity of the situation. Referring to that statement, the court finds that regard for the life or security of others justified the continuation of the mechanical restraint of [the applicant] from 9.30   a.m. on 5 June 2019 until 8.18   p.m. on 16 June 2019; thus, the restraining measure was in accordance with section 14(3) of the Mental Health Act. The Psychiatric Patients’ Complaints Board expressed concern about the fact that the mandatory medical assessment after 48 hours on 5 June 2016 was performed by B.J., the treating chief psychiatrist, and that on more than one occasion the time span from one medical assessment to the next was around 12   hours or more, which was not in accordance with the rules in section 21 of the Mental Health Act. The court finds that the circumstances that the mandatory medical assessments under section 21(4) of the Mental Health Act were not performed at regular intervals around the clock and that the mandatory medical assessment after 48 hours required by section 21(6) of the same Act was performed by the treating chief psychiatrist do not amount to such serious disregard for [the applicant’s] legal rights that they could independently justify the finding that the mechanical restraint should be deemed unlawful. In making this finding, the court has taken into account that ongoing medical observation [by members of staff] was performed around the clock, but that the medical assessments were not performed at regular intervals as the staff considered that it was better to allow [the applicant] to rest than to perform the medical assessments at the usual intervals and that both the mandatory 24-hour medical assessment and the ... medical assessment on the fourth day were performed by external psychiatrists, both of whom assessed that the conditions for mechanical restraint had been met. Based on the above, the court deems that the mechanical restraint of [the applicant] was lawful and dismisses the claim against the Region of Southern Denmark for ... damages. The court finds that the circumstances that the mandatory medical assessments under section   21(4) of the Mental Health Act were not performed at regular intervals around the clock and that the mandatory medical assessment after 48 hours required by section   21(6) of the same Act was performed by the treating chief psychiatrist do not amount to such serious disregard for [the applicant’s] legal rights that they could independently justify the finding that the mechanical restraint should be deemed unlawful. Based on the above, the [c]ourt deems that the mechanical restraint of the complainant was lawful and dismisses the claim against the Region of Southern Denmark for payment of damages.” 30 .     The applicant appealed against that decision to the Eastern High Court ( Østre Landsret ), which by a judgment of 6 October 2020 found in his favour for the following reasons: “Introductory observations ... [the applicant] has not disputed the lawfulness of the mechanical restraint from 1.30 p.m. on 3   June 2016 to 9.30 a.m. on 5 June 2016. ... The case thus concerns whether the mechanical restraint of [the applicant] from 9.30   a.m. on 5   June 2016 to 8.18 p.m. on 16 June 2016 was lawful and, if not, whether he is entitled to damages and, if so, the amount of such damages. Lawfulness of the mechanical restraint It follows from section 14(2)(i) of the Mental Health Act that mechanical restraint may normally be used only briefly, that is, for few hours, see subsection (3), and only to the extent necessary to prevent a patient from subjecting himself/herself or others to an imminent risk of harm to body or health. It appears from the preparatory notes to that provision that the concept of ‘imminent risk’ must be construed to mean a ‘ specific, present and demonstrable risk’ . According to section 14(3) of the Mental Health Act, mechanical restraint can be used for a period of more than a few hours if justified having regard to the life, health or safety of the patient or others. According to the preparatory notes to the provision, it is a requirement that there must be ‘substantial reasons’ in the form of an ‘imminent and substantial risk’ to the person himself/herself or others, whereas a distant or uncertain risk that such risk may manifest itself does not suffice. It also appears from the preparatory notes to the 2015 Act amending section   14(2) and (3) of the Mental Health Act and other provisions that, based on, inter alia , the repeated concern expressed by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), the amendment was intended to reduce the use of mechanical restraint by 50%. The relevant provisions must also be viewed in connection with the general provisions on proportionality set out in section 4 of the Act and the rules in section   21(4) to (6) of the Act on continuous medical supervision and [regular] assessments by an external chief psychiatrist in connection with belt restraint, which, according to the preparatory notes to those provisions, constitute due process protection of the rights of mechanically restrained patients. In the case at hand, [the applicant] assaulted a nurse in a very serious and dangerous manner on 3 June 2016 at around 1.30 p.m. without prior warning, which was the reason why he was mechanically restrained. During the period of mechanical restraint, he displayed labile behaviour, irascibility, irritability, and a refusal to accept his responsibility for the assault, etc. During the first medical assessment at 7.30 p.m. on 3 June 2016 it was decided to release one strap so that [the applicant] had one limb free from that point on. At the same time, staff began to alternate [the limbs on which] the three remaining straps [were placed] approximately every thirty minutes. In connection with one of those alternations (at 8.10 a.m. the next morning), [the applicant] lashed out at a nurse, but became cooperative ... after he had been ‘severely reprimanded’. It is not apparent from the medical records whether, between then and the medical assessment at 9.30 a.m. on 5 June 2016 [the applicant] lashed out at nursing staff or doctors in connection with the regular alternation of straps or the medical assessments. In connection with the medical assessment at 9.30 a.m. on 5 June 2016, [the applicant] was described as shouting, being irascible and exhibiting behaviour that was difficult to control. No information has been provided as to whether [the applicant] made verbal threats of violence during with the medical assessment in question or on previous occasions during the period of mechanical restraint. It was decided in connection with the medical assessment that [the applicant] should continue to be mechanically restrained and that the restraining devices should continue to be a belt and three straps. According to the case notes entered on 4 June 2016 at 1.30 p.m., there seems to be doubt as to whether the relevant medical assessment was performed by a doctor not working at the P1 Ward and thus whether the medical assessment was in fact made by an external chief psychiatrist as required by section 21(5) of the Mental Health Act. Against this background and since no attempt was otherwise made, for example, to release yet another strap and then assess [the applicant’s] behaviour in that situation, the High Court finds – despite the sudden and highly aggravated assault on 3   June 2016 and [the applicant’s] serious mental illness, labile behaviour, etc. – that it has not been justified that the mechanical restraint had to continue after 9.30 a.m. on 5   June 2016 out of regard for the life, health or safety of the patient or others. The mechanical restraint of [the applicant] after 9.30   a.m. on 5 June 2016 was therefore not lawful [nor in accordance with] section   14(2) and (3) of the Mental Health Act. Damages [The applicant] has accordingly been mechanically restrained without justification for a continuous period of almost eleven and a half days. Considering the resulting stressful situation, the High Court finds that Article   3 of the European Convention of Human Rights has been violated and that [the applicant] is therefore entitled to damages for such violation ... In determining the amount of the damages, it must be taken into account, on the one hand, that [the applicant] was mechanically restrained on the bed without justification for almost eleven and a half days, which must be considered a serious interference. On the other hand, it must also be taken into account that the continuous medical assessment of the justification of the mechanical restraint must be deemed to have been difficult owing to [the applicant’s] serious mental illness and the way that it manifested itself, including his labile and unforeseeable behaviour leading to an unprovoked and highly aggravated assault on a nurse two days earlier. Based on an overall assessment, 50,000 Danish kroner is considered to be a suitable amount of damages ...” 31.     The applicant was granted leave to bring an appeal seeking a higher amount of damages in the Supreme Court ( Højesteret ). 32 .     The Region of Southern Denmark made an application to the Supreme Court seeking that the Medico-Legal Council ( Retslægerådet) be consulted. The application was granted, and on 25 April 2022 the Medico-Legal Council issued the following opinion: “In connection with our reply to the request, the Medico-Legal Council would like to refer to a number of previous opinions concerning [the applicant], most recently the opinion of 5 November 2021, and would now say, based on the case-files received, including the medical report of 5 April 2019 prepared by B.J., chief psychiatrist of Psychiatric Ward P1 of the Mental Health Service of the Region of Southern Denmark at Svendborg Hospital, that [the applicant] is now a 26-year-old male who has been ill-adjusted since childhood and who has suffered from a severe mental disorder since early adolescence (diagnosed as severe schizophrenia in 2015), has faced severe cognitive challenges and has abused various intoxicants. Prior to the relevant period of mechanical restraint, he was involuntarily admitted to hospital because of the danger he posed to those around him. He grew up in Copenhagen but moved to the island of Funen in 2015 at the age of 20 at the initiative of his family, who wanted to distance him from gang-related criminal environments. He mostly lived with family members as none of the socio-psychiatric residential homes offered to him were able to cater to his needs. According to medical records, [the applicant’s] family requested that he be admitted to the Psychiatric Unit on 10   May 2016 after a violent incident against a family member. After he had beaten a fellow patient without any warning, [the applicant] was restrained with a belt on 11   May 2016 with the assistance of the police, the restraint measure being terminated after two days. He was discharged a couple of times, but readmitted soon afterwards, and was hospitalised continuously as of 15 May 2016. [The applicant] failed to appear after an agreed temporary leave on 31   May 2016, and it appears from his medical records that he had been in Copenhagen and had been admitted to a psychiatric unit there. On 3 June 2016, he was transferred from the psychiatric unit of Bispebjerg Hospital to the psychiatric unit of Svendborg Hospital for continued hospitalisation. It appears from his medical records that shortly after his arrival [the applicant] became increasingly strained and irritable, threatened the life of employees and assaulted a male employee without any warning by grabbing him around the neck and beating and stabbing him many times in the back of the head. [The applicant] was restrained with a body belt and straps with the assistance of the police owing to the danger he posed to those around him. At the same time, he was forcibly detained. Throughout his hospitalisation [the applicant] was described as severely psychotic and easily provoked to aggression and bursts of anger, which clearly took a turn for the worse when he smoked cannabis. While the mechanical restraint measure was in place [the applicant’s] mental state was described as highly unstable and labile and with pronounced psychotic symptoms, in which state he believed that he [had been] well within his rights to defend himself by the assault of 3 June 2016 and [continued to be justified in] throwing coffee, furniture, etc., at staff, whose lives he continuously threatened. In view of the constant danger he posed to those around him and his severely disordered mental state, which no one had succeeded in stabilising, the chief psychiatrist requested the Ministry of Justice on 9 June 2016 to issue a ‘dangerousness decree’. As, based on a medical assessment, [the applicant] continued to pose an immediate risk of harm to others, it was decided to transfer him to a more secure facility at the Department of Forensic Psychiatry at Middelfart Hospital on 16 June 2016, with him remaining restrained. In connection with the long duration of the restraint measure, prophylactic medical treatment against thrombosis was prescribed and forcibly administered. As of 7 June 2016, the belt was gradually released for short periods of time in the presence of police officers. Based on the medical assessment that he posed an immediate risk of harm to others, it was deemed reckless to terminate the belt restraint. On this basis, the Medico-Legal Council will answer the questions asked as follows: Question 1: The Medico-Legal Council has been asked to assess whether it was medically correct to continue the mechanical restraint [of the applicant] with a belt until 8.18   p.m. on 16   June 2016, see form 3. In its reply, the Medico-Legal Council has been asked to state whether, based on a medical judgment, it was necessary to continue the mechanical restraint of [the applicant] having regard to the life, health or safety of himself or others. It is the opinion of the Medico-Legal Council, on the basis of its medical assessment, that [the applicant] continued to pose an ongoing risk to those around him owing to his highly unstable, psychotic state during the relevant period, and it [assesses] that the risk could not have been averted by less intrusive measures. Question 2: The Medico-Legal Council has been asked to assess whether it was medically correct to apply straps during the period from 9.30 a.m. on 5   June 2016 to 8.18 p.m. on 16   June 2016. Yes, reference being made to the initial paragraph and the answer to question 1. Question 3: If question 1 or 2 is answered in the negative, whether in full or in part, the Medico-Legal Council is asked to state whether it finds part of the period of restraint to be justified and, in that case, which period. The question is no longer relevant. Question 4: Does the case in general give rise to any comments from the Medico-Legal Council? No.” 33 .     Before the Supreme Court B.J. gave additional testimony and stated, among other things: “...The diagnosis of ‘hebephrenic schizophrenia with a low IQ score’ was schizophrenia beginning at a very early age and being mainly characterised by unpredictable mood swings and incoherent behaviour. This means that it was difficult to know beforehand how the patient would react since the diagnosis was mainly characterised by incoherent behaviour and unpredictability. ... When reminded of the case notes of 9.30 a.m. and 1.22 p.m. on 5   June 2016, when she had assessed [the applicant] and described him as angry and verbally threatening, the witness stated that the problem had most likely been that his emotions had been very labile all the time. At one moment [the applicant] had threatened to kill and stab the [staff], the next he had laughed for no apparent reason. [His emotions] had simply changed from one hour to the next and that was why she had maintained the mechanical restraint. That was how it had been all the time. As soon as they had tried to control his behaviour, things had gone entirely astray. At the medical assessment at 10.30 a.m. on 6 June 2016, she had told [the applicant] that she really did not dare to release him, but that she had tried ... all possible ways to find a solution. She had been honest with [the applicant] and had said that from her perspective, she [could not] release him into [the] ward, but that she had tried all other solutions possible. She had also told [the applicant] that she was trying to have the police come so that he could be released at least once a day until they had found another solution. The witness had also met with the hospital management to discuss what they could do. She had also applied for a ‘dangerousness decree’ and had called the Department of Forensic Psychiatry to ask whether they could help. She had explored all options, as she ... told [the applicant]. The witness was reminded of the following case note of 10.50   p.m. on 6   June 2016 ‘Wrist and foot straps changed every hour as ordered. Cooperates well until at 10.30   p.m. [and until then] the patient’s behaviour is controlled [but] he suddenly turns angry, makes threats and shouts, “my restraining belt must not be tightened, I don’t want my mattress sheets changed, I don’t care about whom I knocked down”, “I wish I had a knife, then I would stab him again!!!”‘ The witness stated that this was how they had seen [the episode]. It had occurred without any warning whatsoever. He had suddenly become so angry, so angry. They had seen similar affective reactions when [the applicant] had beaten a fellow patient and had stabbed a fork into the back of the nurse’s head. ... When reminded that it appears from the case note of 2.34   p.m. on 9   June 2016 that she had applied for a ‘dangerousness decree’, the witness stated that that was the first time that she had applied for such an order. The reason for making the application was that she had considered [the applicant to be] a really dangerous patient whom she did not know what she could otherwise do with. The purpose was to have [the applicant] transferred to the High-Security Psychiatric Ward. From her perspective, [the applicant] had not fitted into a general psychiatric unit and the Department of Forensic Psychiatry had refused [to take him]. [She considered the applicant] a really dangerous patient who belonged in the High-Security Psychiatric Ward. Based on her medical assessment of [the applicant] on that particular day, it [had] continued to be her assessment that there was an imminent risk that he was dangerous. ... When reminded that it appears from the case note of 4.35 p.m. on 12 June 2016 that they had applied wrist straps [to the applicant] again, the witness stated that [the applicant] had thrown a table and a chair. She had considered the situation so problematic that it had no longer been sufficient to keep the patient restrained with just foot straps and a belt. She really felt that she had considered whether there were other options than mechanical restraint. She had had at least one and probably ... two meetings with the hospital management to discuss whether they had any other options. However, they had not been able to identify any. She therefore considered that they had not been able to identify any other alternatives to mechanical restraint in a general psychiatric ward. It had been too dangerous. She believed that [the applicant] was the most dangerous patient she had ever met. As far as she recalled, and having reread his medical records, the combination of low intelligence, unpredictability, a violent temper, abuse and his criminal and violent history was what had made the patient dangerous. She had been aware from the beginning that he was a very dangerous patient.” 34 .     By a judgment of 26 October 2022, the Supreme Court found against the applicant for the following reasons: “[The applicant] was mechanically restrained from 1.30 p.m. on 3   June 2016 to 8.18   p.m. on 16   June 2016 while hospitalised at Svendborg Hospital. Like in the proceedings before the District Court and the High Court, he has not disputed the lawfulness of the mechanical restraint until 9.30 a.m. on 5 June. The issue is then whether the mechanical restraint was also lawful during the following period ending at 8.18 p.m. on 16 June and, if the mechanical restraint was not lawful, the issue is then to [decide to] what extent he is entitled to damages. The mechanical restraint measure was first applied at 1.30 p.m. on 3 June after [the applicant] had assaulted a male employee at the hospital with a stainless-steel fork, which, according to his medical records, he had stabbed into the back of the employee’s head and ... upper back nine times without any warning. It also appears from his medical records that he had lashed out at an employee on two occasions on 4   June and that he had threatened the life or health of staff members on several occasions after 5   June. The Medico-Legal Council said in its opinion of 25 April 2022, inter alia , that [the applicant], who had been diagnosed with severe schizophrenia in 2015, was admitted to the psychiatric unit of Svendborg Hospital on 10 May 2016. After he had beaten a fellow patient without any warning, he was restrained with a belt for two days from 11   May 2016 with the assistance of the police. After a period of hospitalisation at the psychiatric unit of Bispebjerg Hospital, he was transferred to the psychiatric unit of Svendborg Hospital on 3 June 2016 for continued hospitalisation. It appears from his medical records that shortly after his arrival he became increasingly strained and irritable, threatened the life of employees and, as mentioned above, assaulted a male employee without any warning by grabbing him around the neck and beating and stabbing him many times in the back of the head. He was mechanically restrained with a belt and straps with the assistance of the police. In its written opinion, the Medico-Legal Council also stated that, in the period until 16   June when he was transferred to the Department of Forensic Psychiatry at Middelfart Hospital, [the applicant’s] mental state was described as highly unstable and [emotionally] labile with pronounced psychotic symptoms, and that, according to his medical records, he had expressed the view