MINISTERS’ DEPUTIES

Notes on the Agenda

CM/Notes/1521/H46-2

6 March 2025

1521st meeting, 4-6 March 2025 (DH) Human rights   H46-2 Strazimiri v. Albania (Application No. 34602/16) Supervision of the execution of the European Court’s judgments Reference documents DH-DD(2025)29, DH-DD(2024)655, CM/Del/Dec(2024)1501/H46-1

 

Application	Case	Judgment of	Final on	Indicator for the classification
34602/16	STRAZIMIRI	21/01/2020	21/05/2020	Structural problem

·  Co-operation project: PMM 2968 – Horizontal Facility III ‘‘Enhancing the protection of human rights of prisoners in Albania.’’

Case description

The applicant, suffering from mental illness, was found in 2011 not to be criminally responsible for attempted murder and was placed in inpatient compulsory treatment. He was found by the Court to have suffered inhuman and degrading treatment due to the cumulative effect of the poor material conditions at the Tirana Prison Hospital and the insufficient psychiatric and therapeutic treatment he received (violation of Article 3), to have been unlawfully detained, as he was not placed in a special medical institution as required by domestic law for persons subject to court-ordered compulsory treatment (as such an institution did not exist in Albania), and was not provided with an appropriate environment and therapeutic care (violation of Article 5 § 1). It further concerns the failure of the Supreme Court to promptly examine his appeal against detention of 2016 and the absence of a right to compensation for unlawful detention (violations of Article 5 §§ 4 and 5).

The Court indicated, under Article 46 of the Convention, that the authorities should secure as a matter of urgency the administration of suitable and individualised therapy to the applicant and consider the possibility of his placement in an alternative setting outside of the penal facilities. It further indicated that the respondent State should expeditiously take the necessary measures to secure appropriate living conditions and the provision of adequate health care services to mentally ill persons who are subject to deprivation of liberty based on a court-ordered compulsory medical treatment. The Court added that the authorities should establish an “appropriate institution” to accommodate such persons with a view to improving their living conditions. Any such institution must respect the therapeutic purpose of this form of deprivation of liberty, pharmacological treatment should be combined with other forms of therapeutic treatment as part of an individualised treatment plan, and enough qualified mental health care staff should be recruited. In addition, the authorities should consider, where appropriate, the possibility of outpatient mental health treatment.

Status of execution

The authorities provided updated information on 7 June 2024 (DH-DD(2024)655) and an updated action plan on 2 January 2025 (DH-DD(2025)29).

Individual measures

1) Applicant’s material conditions at the provisional Lezha Special Institution[1]

Previous information submitted by the authorities indicated that he was placed in a cell that did not meet the minimum standard of living space. In January 2025, the authorities reported that the applicant is now placed in a cell with living space of five sq.m. per person. He is free to move outside the cell to the common areas during the day. Moreover, several improvements to the facility have been carried out to ensure adequate hygiene, lighting, ventilation, temperature, furniture, shaded outdoor areas and clothing.

2) Individualised therapeutic treatment and measures to reduce the negative effects of the carceral environment on the applicant’s therapeutic treatment

In their submission of June 2024, the authorities indicated that an individualised, multi-disciplinary treatment plan is prepared, implemented, and regularly reviewed by a psychologist and social worker. Periodic (scheduled and ad hoc) consultations with a psychiatrist are provided and medication is administered according to the psychiatrist's recommendations.

The treatment plan includes weekly psychosocial activities tailored to the applicant's needs to mitigate the negative effects of the carceral environment. These include occupational therapy (painting), individual counselling, social skills development, sports, regular health updates to his family, monthly family meetings, and weekly group therapy (five life skills courses). Authorities noted that his psycho-emotional and functional balance is stable with slight progress in counselling, but his participation in rehabilitative activities is hindered by difficulties in maintaining logical flow and coherence.

3) Periodic (annual) judicial review of the need for the applicant’s continued confinement

The action plan of January 2025 indicates that such review lastly took place in December 2022, preceded by reviews in March 2019, June 2017, November 2015, February 2014, January 2013 and October 2010.

4) Information from the Albanian Helsinki Committee on the applicant’s situation (DH-DD(2024)755)

In its communication of June 2024, the Albanian Helsinki Committee (AHC) indicated that the applicant continued to be kept in a penitentiary institution, treated in the same manner as convicted and detained persons, with the staff applying rules and risk assessment tools of a penitentiary setting. The AHC also expressed concerns about the adequacy of his individualised treatment as his psycho-social file did not contain regular entries by the staff (with a gap for over a year between 2022 and 2024) and the treatment was limited to pharmacological aspects.

General measures

1) Previous examination by the Committee

The Committee noted with great concern the persistent high overcrowding and the risk of further deterioration in the Lezha temporary institution as indicated by the Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT).[2] It called for urgent measures to curb overcrowding, including through efficient use of the periodic judicial review of the need for continued confinement, and to reduce the negative effects of the carceral environment. It invited once again the authorities to provide their assessment on other possibilities for reducing the number of persons subject to court-ordered compulsory treatment, including outpatient mental health treatment.

It further urged the authorities to provide information, inter alia, on a clear plan for the next steps for the creation of a permanent specialised forensic psychiatric facility, including for ensuring its financing, with a timetable for its construction, as well as on the recruitment of staff.

2) Measures to reduce overcrowding and the number of patients in the Lezha Special Institution

In June 2024, the authorities indicated that the Lezha Special Institution housed 446 persons subject to court-ordered compulsory treatment, with an increase of about 60 persons per year, while the number of patients leaving the institution remained very low. In January 2025, there were 449 patients.[3]

According to the action plan of January 2025, in order to address overcrowding the authorities took several short-term measures: repurposing premises to create new rooms for 41 forensic psychiatric patients, training staff to assess patients for outpatient transfer, and discharging patients through regular judicial re-assessment of the need for their continued confinement and assigning them to compulsory outpatient treatment (see below).

In their communication of June 2024, the AHC indicated that, compared to March 2023 when 404 patients were accommodated at the Lezha Special Institution, the institution now housed 445 persons subject to court-ordered compulsory treatment, well above its official capacity.[4] The rooms accommodated about 7-12 persons.

3) Periodic judicial review on the continued confinement

In the action plan of January 2025, the authorities reported that in 2024 courts had conducted 226 periodic judicial re-assessments of the need for continued confinement of patients under compulsory treatment. Of these, 115 resulted in the continuation of the measure, while 111 patients were discharged. In the information provided during a Secretariat's meeting with the authorities in Tirana in December 2024, it was clarified that among those discharged, 95 were assigned to compulsory outpatient treatment.

In their communication of June 2024, the AHC maintained that during their visit they had established that the psycho-social staff were those who provided legal representation for patients before the courts.

4) Outpatient mental health treatment

With international support, the authorities are re-evaluating all patients and providing post-release support for reintegration and housing for those without family. Specialized mental health services include ten community centres offering outpatient care, ambulatory forensic psychiatric care in the regional hospitals, and 14 facilities providing rehabilitative-residential care for persons with chronic mental health disorders. Hospitalisation services are available in four main regions. The authorities see outpatient services as a way of reducing court-ordered compulsory treatment, but they face challenges in raising awareness and involving local authorities in service provision.

5) Measures to reduce the negative effects of the carceral environment on the therapeutic treatment at the Lezha Special Institution; staffing levels

The authorities indicated policy-related efforts to improve the therapeutic treatment for forensic psychiatric patients through work of inter-institutional working groups developing protocols for managing violent behaviour and creating individual treatment plan forms. In July 2024, the Ministry of Health and Social Protection approved an Order establishing a standardized treatment plan, incorporating recommendations from a Council of Europe-supported study. Additionally, the joint action plan between the Ministries of Health and Justice is under review to implement the CPT recommendations and the Strazimiri judgment.

Moreover, the authorities made efforts to enrich therapeutic tools at the Lezha Special Institution, through a "Life Skills - School" with eight therapeutic modules based on cognitive behavioural therapy; construction of greenhouses as occupational therapy; and bibliotherapy carried out with NGO co-operation.

As concerns the staffing levels, the Lezha Special Institution employs 11 doctors, including three in-house psychiatrists and a part-time psychiatrist from the local hospital who visits weekly. In addition, there are three psychologists (five were previously reported), seven social workers (six were previously reported), and a head of unit. Training of the current healthcare staff in occupational therapy is envisaged. At the meeting with the Secretariat in December 2024, the authorities highlighted difficulties in recruiting medical staff and their efforts to raise awareness at the Medical Faculty to attract professionals.

In their communication of June 2024, the AHC indicated that the number of psycho-social staff and psychiatrists was inadequate to the number of patients and urged a review of the current staffing structure.

5) Living conditions and therapeutic treatment of the female forensic psychiatric patients

In June 2024 the authorities indicated that they had established an inter-sectoral working group to develop the regulatory framework, including staff levels, for a special medical institution for female forensic psychiatric patients in Shkodra. The transfer of the female patients from the Tirana Prison Hospital to the new facility in Shkodra, with a capacity of 35 places, was initially planned for 2024. At the meeting with the Secretariat in December 2024, the authorities clarified that the transfer will take place in the first half of 2025.

6) Planned construction of a permanent forensic psychiatric hospital

With the aim of having this new permanent facility operational by 2030, the Ministry of Health updated the application for funding under the European Union’s Instrument for Pre-accession Assistance III. The application form, published with the authorities’ action plan of January 2025, indicates that it has been decided to allocate land on the Lezha territory, where the Shen Koll Prison is located, for construction of a new forensic psychiatric facility. At the meeting with the Secretariat in December 2024, it was clarified that, following the initial refusal of the European Union to allow the funding, the updated application has been resubmitted for funding.

Public data from the Albanian Council of Ministers indicate that the establishment of the forensic psychiatric institution is included among Albania’s strategic objectives and is foreseen to be completed by 2028.

7) Measures to ensure speedy judicial review of the lawfulness of detention based on court-ordered “compulsory treatment” and right to compensation (violations of Article 5, §§ 4 and 5)

No new information is provided regarding these issues.^[5]

Analysis of the Secretariat

Individual measures

While it is positive that the applicant is currently placed in a cell with living space within the CPT standards and that he takes part in several therapeutic and rehabilitative activities tailored to his needs on a weekly basis, it has to be born in mind that, as the CPT indicated, the setting of the Lezha facility remains a carceral one. Moreover, the severe overcrowding of the facility could undermine the therapeutic purpose of the treatment and render the detention unlawful. Therefore, the Committee might wish to invite the authorities to continue providing information on the applicant’s material conditions of detention and treatment, although the adoption of sufficient individual measures regarding these issues is linked with the adoption of general measures.

Moreover, it could note that, the judicial re-assessment of the applicant’s confinement does not appear to take place annually as required by domestic law. The Committee could thus insist on the need of annual re-assessment, with the applicant being heard in person or represented.

General measures

1) Measures to reduce overcrowding and negative effects of the carceral environment on the therapeutic treatment, and to ensure creation of a permanent specialised institution

As regards the male forensic psychiatric patients, while the authorities have taken certain short-term measures to curb overcrowding at the temporary Lezha Special Institution, the number of patients remains very high. The occupancy rates have further increased, with living space (of average 2.6 sq.m.) being below the CPT standards.

Therefore, the Committee may wish to express its serious concern about the situation and to strongly urge the authorities to redouble their efforts to resolve the issue as soon as possible. It could also invite them to provide an assessment on the impact of the measures adopted, obstacles encountered (e.g. high recourse by courts to confinement of patients and low level of discharges, insufficiency of outpatient care services, etc.) and further measures envisaged to overcome them.

Moreover, an assessment of the statistics and outcome of the regular judicial review, as previously requested by the Committee, is still awaited. The authorities could also be invited to ensure that patients are heard in person by the judge and that proper legal representation is provided.

While certain information is now provided on the availability of outpatient mental health treatment facilities, it is further necessary to clarify a number of aspects, to allow proper assessment of their effectiveness, including data on number of discharged patients placed in such services, the staffing levels, and an assessment of the sufficiency of the services as compared to the number of beneficiaries.

It is positive that through a number of ongoing initiatives and training of staff, the authorities aim to reduce the negative effects of the carceral environment in the temporary institution on the patients’ therapeutic treatment. They could be encouraged to continue and expand these initiatives. At the same time, the current levels of the specialised staff continue to be low as compared to the high number of patients at this institution and as compared to European standards and practices in other Member States.[6] The Committee may wish thus to invite the authorities to increase their efforts to recruit sufficient specialised staff, if necessary to revisit the current staffing structure, and to keep it regularly informed on recruitment of staff.

As regards female forensic patients, the authorities could be urged to follow on their commitment to relocate the female patients from the Tirana Prison Hospital to the Shkodra facility in the first half of 2025, ensuring adequate conditions of detention and therapeutic treatment in that latter facility.

As regards the creation of a permanent specialised forensic psychiatric facility, indispensable for the full implementation of this judgment, the authorities have provided now more concrete information about the next steps in the planning of its construction and ensuring the financing. They should be invited to keep the Committee regularly informed about any developments, including on the financing, and be encouraged to explore different financial mechanisms available at national or regional level and diversify fund-raising options in this respect. They could also be invited to share additional information in a form of a feasibility study or similar documents prepared in support to the establishment of the permanent facility.

In addition, the authorities should be once again called to provide the still awaited information on the rules concerning the establishment, organisation and functioning of the special medical institutions, and on domestic avenues for the persons concerned to seek improvement of their conditions of detention and care.

Finally, it is positive that the authorities continue benefiting from the Council of Europe’s expertise through the Horizontal Facility III 2023-2026 Programme “Strengthening the protection of human rights for convicted persons in Albania”. They could be strongly encouraged to continue their ongoing co-operation.

2) Measures to ensure speedy judicial review of the lawfulness of detention based on court-ordered inpatient compulsory treatment and right to compensation (violations of Article 5, §§ 4 and 5)

Information is still awaited, as concerns the violation of Article 5 § 4, for case-law examples on examination of appeals against court decisions ordering detention, for clarification if the general compensatory remedy for excessive length of judicial proceedings has been used to redress violations of Article 5, and for the authorities’ assessment whether further specific measures are deemed necessary.

Financing assured: YES