Involuntary detention: what the courts say

One UN body says abolish it. Two others disagree.

The UN Committee on the Rights of Persons with Disabilities holds, in General Comment No. 1 (2014) and its 2015 Guidelines on Article 14, that detention on the basis of impairment and forced psychiatric treatment violate the Convention and must be abolished. Verbatim: "forced treatment by psychiatric and other health and medical professionals is a violation".

That is the interpretation of one treaty-monitoring body. It is not binding law, and it is disputed.

[13] CRPD/C/GC/1 (2014), §§40, 42 · [14] Guidelines on Article 14 (2015) · [15] Human Rights Committee, General Comment No. 35 · [16] ECtHR, Rooman v Belgium, Grand Chamber

Two rulings against Greece — and what for, exactly

The European Court of Human Rights has found Greece in violation of Article 5 § 1 (e) in exactly two psychiatric-detention cases, both in 2011: Venios (no. 33055/08) and Karamanof (no. 46372/09).

In both, the violation was that Greek law itself had not been followed — Law 2071/1992. In Venios, a hospital psychiatrist ordered internment without the intervention of the prosecutor or the court, and the applicant was detained 37 days without judicial review, never summoned to appear. In Karamanof, the statutory time limits were missed and the applicant was held eight days after a court had refused to order his detention.

What the statute itself requires, so the scale of the breach is visible. Under Articles 95–99 of Law 2071/1992, if the prosecutor decides on confinement he must submit a request to the competent Court of First Instance within three days, and that court must convene within ten days — thirteen days in all to judicial review. The involuntary hospitalisation itself may not exceed six months. In Venios the applicant was held 37 days. [63]

Neither judgment holds that involuntary commitment in Greece is contrary to the Convention. Both are findings of non-compliance with safeguards that already exist in Greek law. The problem is not the statute; it is that the statute was not applied.

[17] Venios v Greece, no. 33055/08, 05.07.2011, §§53, 55 · [18] Karamanof v Greece, no. 46372/09, 26.07.2011

Greece is not Europe's leader in involuntary admissions

It circulates that Greece has the highest rate of involuntary admission in Europe. That is refuted by the very paper cited for it.

The two quantities are of different kinds and do not compare with each other. Anyone who puts them in the same sentence — in either direction — is misinforming you.

The Greek numbers for the drugs — anxiolytics rising while every comparable country falls, and 1.2 million hypnotic prescriptions in three years — are on the sister site: Part E of psychdrugs.org.

[19] Stylianidis S et al., Int J Law Psychiatry 2017;52:28-34, DOI 10.1016/j.ijlp.2017.04.001 · [20] Sheridan Rains L et al., Lancet Psychiatry 2019;6(5):403-417

The forms that make detention lawful: complete in 28% of files

British Columbia's Mental Health Act requires five forms for every involuntary admission: a medical certificate, a treatment authorisation with an assessment of the capacity to consent, notice to the patient of their rights, and two forms for the nomination and notification of a near relative. The province's Ombudsperson asked every health authority for the files of all involuntary admissions in one month — June 2017, 1,468 sets of forms.

Finding: only 412, or 28%, contained all five forms. The treatment authorisation — the form that carries the judgement whether the person can consent — was missing from 24% of files. The rights notice was present in 49%, and had been completed on the day of admission in only 13%. The notification to a near relative was present in 32%: the families of 997 people did not receive the required formal notice. Two health authorities said their emergency departments "usually did not complete" three of the forms for short detentions. "While we found pockets of good practice in some facilities, the overall picture is not positive," the report writes, with 24 recommendations.

Why it is here. The two rulings above concern Greece because Greece's own law was not followed. British Columbia is the same finding in statistical form: the law prescribed the procedure, and the procedure was not followed in two thirds of cases — not in one hospital, but across every authority in the province. The form is not bureaucracy. It is the only evidence that someone judged, on the day of admission, whether the person could say "no".

[91] Office of the Ombudsperson (British Columbia), Special Report No. 42 "Committed to Change", March 2019