Last Updated on January 9, 2024 by LawEuro
European Court of Human Rights (Application no. 30138/21)
The application concerns, under Articles 3 and 5 of the Convention, the applicant’s detention in the psychiatric unit of the Caxias Prison Hospital. Following his conviction on charges of criminal damage, making threats and sexual harassment he was sentenced to a preventive detention measure (medida de segurança de internamento). The applicant complained of the conditions of his detention in Caxias Prison Hospital and submitted that he should have been held in a psychiatric facility in order to have access to the requisite medical care.
The Court notes, firstly, that the existence of the mental health problems which led to the applicant’s detention is not disputed. He was placed under preventive detention on the basis of a serious mental illness rendering him incapable of controlling his actions. In consequence, he was detained in the psychiatric unit of the Caxias Prison Hospital, where he was held from 14 April 2021 until his transfer on 18 October 2021 to the Sobral Cid Hospital.
Since the applicant has complained under Article 3 of the Convention of the material conditions of his detention and the inadequacy of the medical treatment he received in the psychiatric unit of the Caxias Prison Hospital, the Court will concentrate its examination of the complaints under Article 3 of the Convention on those elements which concern the period of detention in that unit. When examining Article 3 complaints, account must be taken of the cumulative effects of the conditions of detention and any inadequacy of the medical treatment.
The Court notes that the parties disagree as to the conditions of detention and the care received by the applicant in the psychiatric unit of the Caxias Prison Hospital. It acknowledges the findings of the CPT report of 27 January 2018, which were emphasised by the Government in their observations. However, in its analysis, the Court draws on the findings of the CPT in its reports of 13 November 2020, as well as those of the reports of the NPM of 2019 and 2020 and other relevant UN human rights monitoring bodies, which have identified mental health-related issues as one of the main challenges facing the prison system in Portugal. Those reports shed light on several general problems associated with detention conditions and healthcare provision in prisons for detainees with mental illnesses, who in principle should be placed in suitable facilities for psychiatric treatment but are not because of a lack of spaces, as was the case with the applicant. For instance, with particular reference to the situation in the psychiatric unit of the Caxias Prison Hospital, the NPM pointed out that accommodation was inadequate and that there was a lack of staff and of clinical adequacy, especially in view of the principle of individualised treatment required in such situations. Those major concerns are supported by similar findings by the CPT, according to which overcrowding continued to be a serious problem that negatively affected the living conditions, staff-inmate relations and the maintenance of good order in that prison hospital. In the CPT’s view, patients in that situation did not have an adequate therapeutic environment, which should include an increased variety and number of organised activities being offered daily and the provision of adequate facilities for occupational and recreational activities.
In the Court’s view, those findings and conclusions call into question the Government’s claims as to the suitability of the psychiatric unit of the Caxias Prison Hospital for the detention of seriously mentally ill patients such as the applicant and, in his particular case, as to the appropriateness of the medical treatment he received in that facility, particularly in the light of the principle of individualised treatment.
Furthermore, the Court notes the concerns expressed in the annual report for 2021 of the DGRSP, according to which the psychiatric unit of the Caxias Prison Hospital was intended for the temporary detention of regular inmates with mental health problems. Nonetheless, owing to the shortage of spaces in the regular mental health institutions, in practice it has been housing on a permanent basis mentally ill persons subject to preventive detention who were in need of psychiatric treatment. This issue is also addressed in the NMP report for 2019, which notes that this situation creates great difficulties for the prison system, making it difficult to respond appropriately to the psychiatric and therapeutic needs of people with psychiatric disorders who are imposed a preventive detention.
In this connection, the Court observes that the Government in the present case did not provide any evidence, such as medical reports or a copy of the applicant’s individual therapeutic plan, attesting that he had received individualised, continuous and specialised care and follow-up treatment, and that appropriate therapy and medication had been prescribed and provided to him. For instance, no information has been provided to indicate that he had regular and continued psychiatric follow-up aimed at adequately treating his illness, preventing its worsening, or carrying out preparatory work towards the applicant’s release and reintegration into the community. The Court notes, therefore, that the Government have failed to demonstrate that the applicant received the therapeutic treatment required by his condition, as it has not been shown that the administration of drugs with long-lasting effects was complemented by the implementation of a comprehensive treatment strategy. In circumstances such as these, where the Government have failed to refute the applicant’s consistent allegations with convincing evidence, the Court is prepared to accept the applicant’s account of the conditions of his detention in the psychiatric unit of the Caxias Prison Hospital.
The Court accepts that the very nature of the applicant’s psychological condition rendered him more vulnerable than the average detainee and that his detention in the conditions described above may have exacerbated to a certain extent his feelings of distress, anguish and fear. In this connection, the Court considers that the failure of the authorities to provide the applicant with appropriate assistance and care has unnecessarily exposed him to a risk to his health and must have resulted in stress and anxiety.
In view of the above, the Court concludes that there has been a violation of Article 3 of the Convention.
Application to the present case
It is undisputed that the applicant’s detention amounted to a deprivation of liberty and that Article 5 is applicable. In that connection, the Court observes that, at first sight, the three minimum conditions set out in the Court’s case-law concerning the deprivation of liberty of “persons of unsound mind” have been met in the present case. The applicant suffers from paranoid schizophrenia, a serious mental illness, with which he was medically diagnosed in 2002. His detention was ordered by a domestic court under a “procedure prescribed by law” based on his mental disorder and the danger he posed to himself and others. Prior to that he had been convicted of criminal damage, making threats and sexual harassment, and declared not to be criminally responsible because of his mental disorder. Subsequently, on 19 September 2019, he was sentenced to preventive detention by the Évora Criminal Court, the execution of which was initially suspended for a period of three years subject to the applicant’s compliance with several conditions, including his undergoing the necessary psychiatric treatment and not committing other criminal offences. As the applicant failed to comply with those conditions, on 2 February 2021 the Évora Criminal Court ordered the execution of the preventive detention. That decision became final on 26 March 2021 and was enforced on 14 April 2021, leading to his detention in the psychiatric unit of the Caxias Prison Hospital. Furthermore, the applicant’s detention on the basis of the court order was confirmed by the Supreme Court of Justice on 21 April 2021, which found that the preventive detention was in accordance with the law. The Court notes in this connection that the applicant’s detention was a measure decided in accordance with a procedure prescribed by law and was therefore covered by Article 5 § 1 (e) of the Convention.
In that connection, the Court notes that the conditions in which a person suffering from a mental health disorder receives treatment are also relevant in assessing the lawfulness of his or her detention within the meaning of Article 5 of the Convention. In order to determine whether the detention of the applicant as a “person of unsound mind” has been “lawful” in the present case, the Court, taking into account its findings under Article 3, will assess the appropriateness of the institution in which he was detained, including whether an individualised treatment plan was put in place. Such a plan should have taken account of the specific needs of his mental health and have been aimed specifically, in so far as possible, at curing or alleviating his condition, including, where appropriate, bringing about a reduction in or control over the level of danger posed, with a view to preparing him for possible future reintegration into society.
The Court notes that between 14 April and 18 October 2021, the applicant, who was found to be not criminally responsible, was detained in the psychiatric unit of the Caxias Prison Hospital; the prison hospital is primarily aimed at serving the ordinary prison community suffering from mental illness and is not part of the health system. The Court accepts that the mere fact that the applicant was not placed in an appropriate facility does not, per se, render his detention unlawful. However, the Court reiterates that keeping detainees with mental illnesses in the psychiatric ward of ordinary prisons pending their placement in a proper mental health establishment, without the provision of sufficient and appropriate care, as appears to have been the case with the applicant, is not compatible with the protection ensured by the Convention for such individuals.
Having considered the submissions of both parties and in view of its findings in paragraphs 77-82 above, the Court is not convinced that the applicant was offered appropriate treatment or that the therapeutic environment he was placed in was suitable for his condition. In this connection, the Court reiterates that the level of care provided must go beyond basic care. Mere access to health professionals, consultations and the provision of medication cannot suffice for treatment to be considered appropriate and thus satisfactory under Article 5 of the Convention. Also, as already found in paragraph 80, the Government did not present the therapeutic plan for the applicant or other documents in this respect. Furthermore, having regard to the applicant’s state of health and special vulnerability, the Court also takes note of the impact his detention had on him, namely in aggravating his state of confusion and fear owing to the restrictive and anti‑therapeutic environment that detention in a prison facility entailed.
In view of the foregoing, the Court considers that the applicant’s deprivation of liberty in the psychiatric unit of the Caxias Prison Hospital was not lawful and violated the requirements of Article 5 § 1 (e) of the Convention.
Therefore, the Court concludes that there has been a violation of Article 5 § 1 of the Convention.
CASE OF MIRANDA MAGRO v. PORTUGAL (European Court of Human Rights) 30138/21. Full text of the document.
Leave a Reply