CEDH · CASELAW;CLIN;ENG — 5 juin 2025

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Ukraine - 21180/15 Judgment 5.6.2025 [Section V] Article 3 Effective investigation Positive obligations 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: violation Degrading treatment Inhuman treatment Coercive and prolonged daily administration of neuroleptic medication, in different forms and dosages, with no predetermined course and against the applicant’s will: violation Article 5 Article 5-1 Deprivation of liberty Lawful arrest or detention Continued detention despite a court order for the cessation of compulsory impatient psychiatric treatment: violation Article 5-4 Review of lawfulness of detention Inability to challenge the lawfulness of compulsory psychiatric confinement and periodic ex officio judicial review marked by a manifest lack of diligence: violation Facts – The applicant was compulsorily detained for psychiatric treatment in the Dnipro High Security Psychiatric Hospital (“the hospital”), a State-run institution, from December 2012 to October 2014, after a criminal court found that he had attempted to commit murder in 2011 while in a twilight state of consciousness and was thus not criminally responsible. That court noted that although, according to a forensic psychiatric report of March 2012, the applicant had not been suffering from any mental illness prior to the crime and was mentally healthy at the time of the forensic examination and trial, the circumstances and nature of the offence, the sudden onset of his twilight state during the crime and the lack of definitive evidence that the condition would never recur rendered him particularly dangerous to others. After the applicant’s admission to the hospital, he was administered daily neuroleptic medication in various forms and against his will. Subsequently, in March 2013, the hospital psychiatrists’ panel also diagnosed him with an organic personality disorder. Relying on this diagnosis, the panel requested his continued compulsory medical treatment in the hospital, which the District Court granted on three occasions between April 2013 and April 2014 without the applicant’s presence and participation. However, on 13   October 2014, in the applicant’s presence, the District Court refused the hospital’s fourth request. That ruling became final on 24   October 2014. However, the involuntary treatment persisted up to the applicant’s discharge from the hospital on 28 October 2014. The applicant brought a civil claim against the hospital which was partly successful: his compulsory hospitalisation between 24 and 28   October 2014 was found to be unlawful as it lacked any legal basis, and he was awarded the equivalent of about EUR 256 in compensation. Law – Article   5 §   1: As to the admissibility of the applicant’s complaint in respect of his confinement between 24 and 28   October 2014, the Court found he could still claim to be a victim of a violation of Article   5 §   1 as the amount he had been awarded in compensation was much lower than the awards the Court generally made in comparable cases. It could not therefore be considered to have been appropriate redress. Furthermore, the hospital was a public institution, and the acts and omissions of its staff engaged the respondent State’s responsibility under the Convention. On the merits, the Court found that in view of the domestic courts’ findings on the unlawfulness of the applicant’s detention during the relevant period, his continued detention despite the court order to cease his compulsory in-patient psychiatric treatment detention constituted a serious breach of the right to liberty enshrined in Article   5. Conclusion: violation (unanumously). Article   5 §   4: The Court had already found a violation of Article   5 §   4 in Gorshkov v.   Ukraine on the ground that the domestic system of reviewing lawfulness of compulsory psychiatric confinement had lacked the basic guarantee of providing patients compulsorily detained in a psychiatric hospital an independent right to lodge an individual application with a court. While such a right had been introduced into domestic law in 2017, that was after the events in the present case had taken place. The situation was aggravated by the fact that the compulsory hospitalisation in a mental care facility, as ordered by a criminal court, was understood to include the automatic authorisation to treat the patient in question, even against his or her will. In that respect too there was no immediate remedy available to the patient. Although the above considerations were sufficient to find a breach of Article   5 §   4, having regard to the formulation of the applicant’s complaints, the specific context of detention in a psychiatric hospital, as well as the importance of judicial review of the lawfulness of such detention for the effective protection against arbitrary deprivation of liberty and for securing the dignity and physical integrity of the individuals concerned, the Court considered it had to examine the quality of the periodic ex officio judicial review which the Government had claimed was an effective procedure in the applicant’s case. In that respect, the Court held that the District Court’s examination of the applicant’s case, in his absence, until 13   October 2014, had been marked by a manifest lack of diligence on that court’s part and had been incompatible with the basic requirements of justice. In particular, prior to the above date, the District Court had not critically assessed the hospital’s submissions before granting its requests to continue the applicant’s compulsory treatment based on the diagnosis made at the hospital in March 2013. Its decisions had been almost identical, lacked detailed reasoning and essentially repeated the conclusions of the hospital’s assessments without conducting any independent analysis to determine whether he had indeed been suffering from a mental disorder of a nature and degree to justify his continued compulsory confinement. The District Court’s decisions had also been taken without seeing the applicant in person, observing his behaviour and hearing his perspective, whereas the domestic procedural rules, in principle, required his presence at the hearings. His requests for hearings to be conducted in his absence appeared to have been pre-typed; no reasons had been given why he had been unable or unwilling to attend the hearings, nor any justification for proceeding in his absence. Indeed, the case-file material supported the applicant’s allegations that his waiver of the right to participate in the hearings had been coerced. Furthermore, the District Court had not scrutinised the reliability of the arguments based on which the applicant, while having been declared free from any psychiatric illness by forensic experts and the criminal court, had been later diagnosed with a psychiatric disorder by the hospital doctors, who had controlled his liberty and treatment. Nor had a second independent medical opinion been sought to confirm or refute the hospital’s conclusions about his mental state. The Court had already held that the opportunity to benefit from a second, independent psychiatric opinion was an important safeguard against possible arbitrariness in decision-making concerning the continuation of confinement in compulsory care. In addition, the District Court had not assessed the fact that the applicant’s twilight state of consciousness – which had occurred only once, a year before the applicant’s admission to hospital –, had never recurred and had not examined his medical file to properly understand his condition and ascertain whether he posed a danger to others as suggested by the hospital. Lastly, the Court noted that the Ukrainian Ombudsperson, in her 2014 and 2015 reports, had found that depriving patients of their right to participate in court hearings during the consideration of their cases constituted a systemic problem, noting that the District Court had reviewed forty-five cases in a single day in the absence of the patients concerned, basing its decisions solely on hospital reports. That further illustrated the quality of the judicial review and the judges’ reluctance to question medical conclusions. Accordingly, the applicant had been unable to obtain an adequate judicial response for the purposes of Article   5 §   4 and his right to bring proceedings by which the lawfulness of his detention would be decided had been infringed. The Government’s preliminary objection relating to the non-exhaustion of domestic remedies, which had been joined to the merits, was therefore dismissed. Conclusion: preliminary objections dismissed (exhaustion of domestic remedies); violation (unanimously). Article   3: (1) Whether the applicant’s involuntary psychiatric treatment in a closed institution was in breach of Article   3 – (a) The Court’s task in the present case – The parties disputed the medical necessity of the neuroleptic treatment administered to the applicant and that the applicant had suffered from mental health problems necessitating his extended confinement in the hospital. In that connection the Court observed that one of the fundamental principles in modern medical ethics and international human rights law – as widely emphasised across various international instruments, including those of the Council of Europe – was that no medical intervention may take place without the patient’s free and informed consent. The issue of informed consent became more complex in cases involving compulsory medical measures imposed by court order. The very concept of “compulsory medical measures” appeared to conflict with the principle of personal autonomy. At the same time, the justification for such measures often lay in the need to protect either the individual’s health or public safety – considerations that were seen as outweighing and overriding the usual requirement for free and informed consent. Nonetheless, even when compulsory medical measures were considered necessary, they had to be subject to rigorous oversight to prevent potential abuse and to ensure that the interference with personal autonomy was proportionate and justified. In particular, it was essential that the treatment provided was appropriate and necessary. Without such safeguards, the automatic authorisation of treatment without consent risked undermining the individual’s rights in a manner that might be incompatible with the rule of law in a democratic society. (b) The obligation to put in place an appropriate legislative and regulatory framework of protection and investigation – The Court’s understanding from the relevant domestic law and regulations was that in Ukraine a criminal court’s order that a person be subjected to coercive medical measures (such as hospitalisation in a psychiatric facility) was to be seen as constituting an automatic authorisation to administer treatment without that person’s consent. Further, the lack of effective access to an alternative psychiatric examination deprived patients of a crucial safeguard against medical arbitrariness – particularly in cases of allegedly biased or inaccurate diagnoses or treatment. It also significantly undermined their ability to defend their position and advocate for their own health and freedom in court proceedings regarding the continuation of compulsory treatment. Without such access, already vulnerable patients were left in a more vulnerable position – unable to effectively challenge the assessments of the treating hospital. That concern also applied to the right to involve an external psychiatric specialist in the work of the psychiatrists’ panel at the receiving hospital that decided on the need for the continued psychiatric treatment. In the absence of any procedural framework implementing that right, the safeguard remained entirely theoretical. Moreover, in view of the absence of a provision for patients to initiate earlier reviews themselves, the reviews at six-monthly intervals alone, as available at the relevant time, could not serve as an effective safeguard against potential abuse in the diagnosis or treatment process. Leaving a patient without the possibility of a prompt review of the accuracy of his or her diagnosis and the appropriateness of involuntarily administered medication for such a long period could have potentially serious consequences for the patient – including adverse changes in his mental state and behaviour – leaving him vulnerable to unnecessary harm. In addition, the Government had failed to demonstrate the existence of any legal provisions or safeguards governing the use of medications as chemical restraints. Nor had it shown that the general right for patients to lodge complaints about any decisions, actions, or inactions on the part of medical personnel to the hospital director, higher authorities, administrative bodies, or courts, could enable prompt intervention by an independent authority with the power to intervene directly in the diagnostic process or medication administration, and to detect and prevent potential arbitrariness or abuse. In fact, the applicant’s grievances had not been properly recorded or addressed by the chief doctor or hospital director, as required, and had been largely met with orders either to continue the administration of anti-psychotic drugs or to increase their dosage. The Court was also not persuaded that the applicant would have been allowed to send any complaint to an outside authority while detained in the hospital or that an appropriate mailing service or other means of communication with the outside world – properly protected by specific and practical safeguards ensuring the privacy of communication – existed in the hospital at the time. Nor had the Government provided any examples of a successful complaint lodged by an inmate of a psychiatric hospital about his or her psychiatric treatment or any other issue. In any event, in view of the failure to investigate the applicant’s allegations (after his release) that he had been misdiagnosed and subjected to unnecessary compulsory treatment with neuroleptics, the Court was not persuaded that his complaint would have had realistic chances of success. Accordingly, the Court held that the domestic legal framework existing at the time had fallen short of the requirement inherent in the State’s positive obligation to establish and apply effectively a system providing protection to patients undergoing compulsory medical treatment in mental care facilities against breaches of their integrity. The absence of proper legal safeguards had deprived the applicant of the minimum degree of protection to which he had been entitled under the rule of law in a democratic society. (c) The treatment to which the applicant was subjected at the hospital – In view of the absence of procedural safeguards, the deficiencies in the proceedings before the District Court prior to October 2014 and in the compensation proceedings, as well as the criminal authorities’ failure to duly investigate the applicant’s relevant allegations after his release, the Court could not benefit from any domestic assessment or finding that could have been made as to the existence of a therapeutic necessity for the applicant’s prolonged stay in the psychiatric hospital and treatment. It thus proceeded on the basis of the positions of the parties and the evidence available to it. The forensic psychiatric report from March 2012 had declared the applicant to be healthy and free from any mental illness, concluding that the twilight state of consciousness that he had experienced in December 2011 had been an isolated and resolved episode triggered by alcohol intoxication on the background of head injuries sustained in the past. That conclusion had been clear and uncontested by the criminal court, which seemed to have ordered the applicant’s compulsory hospitalisation chiefly by way of a preventive measure, taking the view that despite the absence of any mental illness the applicant remained dangerous to others in the absence of guarantees that his twilight state would never recur. It transpired from the hospital admission documents that “the twilight state of consciousness (resolved)” had remained the only clinical diagnosis until March 2013 when the hospital committee had declared the applicant to be mentally ill. Consequently, the medical ground for his keeping in hospital until then was unclear. Moreover, the daily administration of neuroleptic medication, in different forms and dosages and without a predetermined course and without the applicant’s consent, had persisted throughout his hospitalisation even after the cessation of coercive medical measures had been ordered. It transpired from the applicant’s medical file that neuroleptics had been administered in response to his behaviour and not as part of his treatment programme. There was no credible evidence – as confirmed by the District Court in its decision of 13   October 2014 – indicating manifestations of acute psychotic symptoms during his stay in the hospital, such as hallucinations, delusions, dangerously aggressive behaviour or recurred twilight state. Instead, it was apparent that the administration of neuroleptics – and the changes made to the application form and dosage – had coincided with and followed the applicant’s refusal to admit his guilt for his crime because he could not remember its details; his consistent assertions that he was mentally healthy; his persistent questioning of the need for his continued hospitalisation and treatment; his complaints about the “detention issues”; and his expressed frustration regarding these matters. No satisfactory explanation had been given as to why the applicant’s frustration had been addressed in this manner. Although those reactions had been entirely normal for someone in the applicant’s position, they had been presented by the hospital as dangerous manifestations of mental illness that warranted prolonged treatment in a high-security facility, and had been met with the uninterrupted administration of neuroleptics. There was sufficient evidence indicating a retaliatory motive for the applicant’s retention in the hospital and for his treatment and that the latter was not therapeutic but aimed at exerting control over his behaviour. The applicant’s allegation that neuroleptics had been commonly used by the medical staff as a means of punishment and control had been corroborated by the statements of other patients of the hospital referred to in various reports issued in 2015 and 2018. The medical necessity for the applicant’s retention in the hospital and his treatment with neuroleptics had thus not been convincingly shown to exist. Moreover, the District Court decision ordering the cessation of coercive medical measures, which was ignored by the hospital until the Ombudsperson and prosecutor intervened, tended to support that conclusion. The Court therefore considered that it could draw inferences in support of the applicant’s version of events. In view of the significant effects of neuroleptics on the central nervous system and the risk of serious side effects – including metabolic disturbances, movement disorders, and sedation – their use raised concerns when there was no confirmed diagnosis of a severe psychotic disorder that might pose a danger to the patient or others. The legal instruments and reports adopted by the United Nations indicated that the administration of neuroleptics without medical necessity might amount to ill‑treatment that was prohibited under the United Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. While the applicant had not claimed that the use of neuroleptics had had any long-term or irreversible effects on his health, the mere fact that he had been subjected to psychiatric treatment with neuroleptics against his will, for almost two years and without proven medical necessity – coupled with a lack of effective legal safeguards against arbitrariness and abuse by the medical staff, and given the immediate cognitive effects of the neuroleptic drugs – had been such as to arouse in the applicant a sense of fear, anxiety, and inferiority that had been capable of humiliating and debasing him. That treatment had constituted a fundamental disregard for the applicant’s human dignity, amounting to inhuman and degrading treatment. (2) Overall conclusion – The Court found a violation of Article   3 on account of the failure to put in place the requisite legal and regulatory framework governing compulsory medical measures in psychiatric institutions, including regarding investigation of complaints about such measures, and on account of the actual treatment to which the applicant had been subjected, including the lack of adequate reaction of the authorities to the issues raised by him and operative measures to protect him. Conclusion: violation (unanimously). The Court also held, unanimously, that there had been a violation of Article 3 on account of the applicant conditions of detention at the hospital. Lastly, it found a breach of Article   13 in that the applicant had not had an effective domestic remedy in respect of his grievances under Article   3. Article   41: 25,000 in respect of non-pecuniary damage. (See Gorshkov v.   Ukraine, 67531/01 , 8 November 2005; Pindo Mulla v.   Spain [GC], 15541/20, 17   September 2024, Legal Summary )   © Council of Europe/European Court of Human Rights This summary by the Registry does not bind the Court. To access legal summaries in English or French click here . For non-official translations into other languages click here .