Important development in the area of mental health detention from the European Court of Human Rights

The European Court of Human Rights’ recent ruling in the case N. v. Romania (decided on 28 November) has important implications in the areas of mental health detention and community living. The applicant was a man diagnosed with schizophrenia who complained about the legality of his detention in various psychiatric hospitals since 2001, on account of unsubstantiated sexual assault allegations that had never been reviewed in court. On 28 November 2017, the Court ruled that his detention lacked a legal basis or justification at least since 2007 (the Court declined to examine the period before 2007, including the initial decision to detain the applicant, for reasons of admissibility). In addition, the Court held that the judicial proceedings for the review of the applicant’s continued detention since 2007 had not afforded sufficient safeguards against arbitrariness. Consequently, the Court found several breaches of Article 5 (right to liberty) of the European Convention on Human Rights and awarded the applicant 38,050 Euro in damages and costs. This is a brief analysis of the main points of interest in the judgment.

The Court criticized the authorities’ failure to undergo a “rigorous” assessment of the applicant’s needs or secure his release in conditions that matched those needs despite a judicial order ending his compulsory hospitalization issued at the beginning of 2017. The Court remarked that this case was symptomatic of a systemic problem in Romania in that there was a lack of social services to assist people transitioning from institutional living. Despite the authorities’ formal adherence to international norms advocating for community living, there was a failure to provide the applicant with suitable services upon his release. In view of these circumstances, the Court took the unusual step of demanding that the applicant be released “without delay […] in conditions meeting his needs.” These findings and the wording of the remedial measure create a crucial new opening in the Court’s jurisprudence in this area, suggesting that Article 5 may be construed to imply a positive obligation incumbent in State Parties to provide the community services needed facilitate the release of individuals from unjustified mental health detention.

The Court also noted the superficial manner in which national courts reviewed the necessity of the applicant’s ongoing detention between 2007 and 2017. In particular, they failed to establish the main criterion in domestic law for detention of this type, namely that the person in question represented a danger to society. National courts impermissibly inferred the existence of danger from allegations of sexual assault that had never been proven in court and from the applicant’s diagnosis in itself. In that respect, the Court recalled under Article 14 of the CRPD, “the existence of a disability could not in itself justify a deprivation of liberty.” The successive sets of proceedings on review were flawed for a number of additional reasons. Notably, the Court criticized the ineffectual performance of the ex officio lawyers appointed to represent the applicant through the years, who had either argued in favor of his continued detention or had left the matter to the discretion of the courts, and never got in touch with him before the hearings took place.

The Court warned that these deficiencies were likely to give rise to other well-founded applications in the future. It therefore indicated additional general measures to the Romanian State: to ensure that the detention of individuals in psychiatric hospitals was lawful, justified and not arbitrary; and to ensure that any individuals detained in such institutions are entitled to take proceedings affording adequate safeguards with a view to securing a speedy court decision on the lawfulness of their detention. The Court uses its power to indicate individual or general remedial measures under Article 46 of the Convention on an exceptional basis, in cases that highlight systemic or structural problems with the potential to generate significant numbers of similar complaints in the future.

The judgment is infused with references to the CRPD and the work of the CRPD Committee. The Court cited with approval Article 14 of the CRPD (“liberty and security of the person”), the CRPD Committee’s statement of interpretation on Article 14, its Marlon James Noble v. Australia decision, with facts that are strikingly similar to those in N. v. Romania, as well as Article 19 (“living independently and being included in the community”). Thus, the N. v. Romania ruling is another step in the process of reconciling the two human rights instruments, including with respect to such divisive issues as mental health detention. Also notable is the Court’s willingness to highlight the systemic underpinnings of the violations found and indicate individual and general remedial measures to the Romanian State. The Court had previously made similar use of its remedial powers in another disability case originating from Romania, Centre for Legal Resources on behalf of Valentin Campeanu, decided in 2014, urging the Romanian authorities to “envisage the necessary general measures to ensure that mentally disabled persons […] are afforded independent representation, enabling them to have Convention complaints relating to their health and treatment examined before a court or other independent body.” These two judgments, in addition to other jurisprudence, constitute a strong platform that Romanian advocates may use to push for badly needed reform in the areas of access to justice and deinstitutionalization.   

The Court’s judgment (in French) is available here:

http://hudoc.echr.coe.int/eng?i=001-178948

The press release (in English) is available here:

http://hudoc.echr.coe.int/eng?i=003-5927675-7571175

The applicants in N. v. Romania, as well as in Valentin Campeanu v. Romania, were represented by Constantin Cojocariu, a lawyer licensed to practice in Romania and based in London.

Persoanele cu dizabilitati in fata Curtii Constitutionale a Romaniei

Pe 6 februarie 2017, Tribunalul Buzau a sesizat Curtea Constitutionala cu o cerere de examinare a constitutionalitatii Articolului 164§1 din Codul Civil privind procedura punerii sub interdictie. Litigiul principal se refera la o cerere de punere sub interdictie introdusa de Spitalul Psihiatric Sapoca din Judetul Buzau, care vizeaza unui pacient diagnosticat cu schizofrenie, internat fortat in diverse spitale psihiatrice de maxima siguranta incepand din 2001. Cererea aflata pe rolul Curtii Constitutionale (Dosar nr. 695D/2017) reprezinta o sansa pentru reexaminarea unei institutii – punerea sub interdictie – anacronice, profund nedrepte si aflata in contradictie flagranta cu drepturile fundamentale ale omului. Acest articol isi propune sa prezinte pe scurt motivele pentru care contest aceasta institutie, reprezentand in acelasi timp un apel la mobilizare in sustinerea clientului meu adresat societatii civile interesate de protectia drepturilor omului.

Procedura punerii sub interdictie consta in privarea de capacitatea de exercitiu a persoanelor cu probleme de sanatate mintala percepute ca fiind incapabile de a-si apara interesele, si punerea lor sub tutela unei terte persoane. Capacitatea de exercitiu rezida in aptitudinea persoanei de a-si exercita drepturile pe cont propriu. Punerea sub interdictie este unul din mijloacele institutionale prin care statul condamna persoanele cu dizabilitati la marginalizare fizica si simbolica, alaturi de formele de invatamant segregate, institutiile rezidentiale, lipsa accessibilitatii etc. Pe de o parte, punerea sub interdictie priveaza persoanele cu dizabilitati de drepturile lor fundamentale, precum accesul la justitie sau dreptul la munca, condamnandu-le la destitutie. Pe de alta parte, punerea sub interdictie, care presupune intre altele pierderea automata a dreptului la vot, marcheaza in mod simbolic persoanele cu dizabilitati ca cetateni de mana a doua, sau chiar ca non-persoane, sens in care se vorbeste de “moartea lor civila”.

Procedura punerii sub interdictie este reglementata in Codul Civil, care precizeaza in articolul 164§1 ca “persoana care nu are discernamantul necesar pentru a se ingriji de interesele sale, din cauza alienatiei ori debilitatii mintale, va fi pusa sub interdictie judecatoreasca”. In ciuda efectelor sale dramatice si permanente asupra persoanei, punerea sub interdictie este instituita cu un minimum de garantii procedurale, in instante blazate si indiferente, cu avocati din oficiu indolenti si ignoranti, cu procurorii sau autoritatile tutelare jucand un rol decorativ, fara participarea efectiva a persoanei vizate, bazat exclusiv pe avizul medicilor psihiatri. In vasta majoritate a cazurilor, procedura punerii sub interdictie are loc cu implicarea activa a familiei, care isi asuma sarcina de tutore. Punerea sub interdictie devine insa aproape imposibila in cazul persoanelor cu dizabilitati fara familie, deseori institutionalizate, in ciuda nevoilor de suport si asistenta evidente ale acestora.

Procedura punerii sub interdictie este infestata de stereotipuri negative cu privire la persoanele cu dizabilitati, vazute, dupa caz, ca niste persoane neputincioase asimilate copiilor, sau ca niste bestii periculoase care trebuie tinute sub atenta supraveghere. Departe de a fi o masura de protectie, dupa cum este prezentata in mod formal, punerea sub interdictie faciliteaza adesea abuzurile impotriva persoanei.  Astfel de abuzuri pot fi comise de familie, care pot incerca manipularea procedurii cu scopul de a prelua controlul asupra bunurile persoanei vizate, sau de autoritati, avand in vedere ca punerea sub interdictie priveaza persoana de accesul la justitie, facilitand controlul fizic asupra acesteia sub forma institutionalizarii sau administrarii de tratament medical fortat. In fine, punerea sub interdictie se preteaza la abuzuri sub forma invocarii sale cu rea credinta in conflictele intre persoane private. O data pusa sub interdictie, persoanei in cauza ii va fi foarte greu daca nu imposibil sa obtina ridicarea masurii. Pe de alta parte, conditiile punerii sub interdictie nu sunt supravegheate efectiv, nici supuse unui control periodic, astfel incat masura devine de facto permanenta.

Punerea sub interdictie, reglementata prin apel la termeni anacronici si profund jignitori (“interdictie”! “alienatie”! “debilitate”!), este un artefact juridic aflat in profunda contradictie cu standardele internationale de drepturile omului pe care Romania este tinuta sa le respecte. Astfel, Curtea Europeana a Drepturile Omului a criticat alte state cu institutii similare pentru motive tinand de inflexibilitate, avand in vedere ca acest regim presupune o falsa dihotomie intre persoane cu si fara discernamant, ca nu corespunde circumstantelor diverse ale persoanelor cu sau fara dizabilitati mintale, si ca nu ofera suficiente garantii impotriva abuzurilor. Dreptul Uniunii Europene interzice discriminarea persoanelor cu dizabilitati in campul muncii sau in legatura cu anumite aspecte ale dreptului la vot, chestiuni care sunt afectate in cadrul procedurii punerii sub interdictie. In mod crucial, institutia punerii sub interdictie este in flagranta contradictie cu etosul Conventiei Natiunilor Unite pentru Drepturile Persoanelor cu Dizabilitati, constand in valori precum demnitatea, egalitatea, participarea si autonomia. Mai concret, Conventia interzice institutiile de tipul punerii sub interdictie, bazata pe substitutia vointei persoanei cu dizabilitati,  dictand inlocuirea lor cu regimuri de suport, in care persoanele sunt ajutate sa ia decizii pe cont propriu.

Tarile din regiune, incluzand de exemplu Letonia, Cehia, Croatia sau Moldova au recunoscut caracterul problematic al institutiilor de tipul punerii sub interdictie, initiind reforme de substanta, deseori in urma unor hotarari judecatoresti la nivel de Curte Constituionala sau Curte Suprema. In Romania este de notorietate situatia dramatica a persoanelor cu dizabilitati, indeosebi ale celor din institutii, insa resorturile ascunse ale acestei stari de fapt raman mai degraba neintelese si neabordate. Intre aceste cauze profunde se afla si institutia punerii sub interdictie, care trebuie urgent reformata. Recent, organizatia neguvernamentala Pentru Voi a propus un proiect de lege care ar modifica unele din trasaturile cele mai problematice ale punerii sub interdictie. Pe de alta parte, litigiul aflat pe rolul Curtii Constitutionale, primul atac frontal impotriva regimului juridic actual din perpectiva drepturilor omului, reprezinta o sansa pentru relansarea unei dezbateri care sa vizeze statutul persoanelor cu dizabilitati mintale in societatea noastra in general, si modalitatile in care acestea pot primi suportul necesar pentru luarea autonoma a deciziilor in mod special.

Pentru mai multe detalii, intrebari sau pentru cei ce doresc sa puna umarul la acest effort, ii invit sa ma contacteze pe adresa de email constantincojocariu@yahoo.com sau pe celelalte canale de comunicare cunoscute.