MINISTERS’ DEPUTIES

Notes on the Agenda

CM/Notes/1501/H46-26

13 June 2024

1501st meeting, 11-13 June 2024 (DH) Human rights   H46-26 Parascineti, Cristian Teodorescu group and N. group v. Romania (Applications Nos 32060/05, 22883/05, 59152/08) Supervision of the execution of the European Court’s judgments Reference documents DH-DD(2024)635, DH-DD(2024)573, DH-DD(2024)429, DH-DD(2023)1378, CM/ResDH(2022)49, H/Exec(2023)5, CM/Del/Dec(2023)1483/A2, CM/Del/Dec(2023)1468/H46-23

 

Application	Case	Judgment of	Final on	Indicator for the classification
32060/05	PARASCINETI	13/03/2012	13/06/2012	Complex problem
CRISTIAN TEODORESCU GROUP
22883/05	CRISTIAN TEODORESCU	19/06/2012	19/09/2012	Structural problem
50131/08	ATUDOREI	16/09/2014	16/12/2014
N. GROUP
59152/08	N.	28/11/2017	28/02/2018	Structural problem
35402/14	R.D. AND I.M.D.	12/10/2021	12/10/2021	Structural problem

Cases description

These cases concern longstanding, structural deficiencies linked to overcrowding, severe shortages of staff and inadequate living conditions, treatment and care afforded to patients in psychiatric establishments in Romania (Parascineti); unlawful or arbitrary deprivations of liberty of patients involuntarily placed in such establishments, as protective measures under the Mental Health Act (Cristian Teodorescu group), or as security measures under the Criminal Code (N. group); insufficient safeguards against such deprivations of liberty; systematic failure to seek consent to psychiatric treatment and absence of minimum legal safeguards attending the forcible administration of psychiatric treatment to involuntary patients (Atudorei and R.D. and I.M.D.).[1]

The European Court found violations of the prohibition of inhuman and degrading treatment (Article 3), of the right to liberty and security (Article 5) and of the right to physical and moral integrity (Article 8).

Status of execution

The Committee of Ministers’ last examination of these cases took place at its 1468^th meeting (June 2023) (DH).

Individual measures:

The just satisfaction awarded by the Court for non-pecuniary damage and costs and expenses was paid.

At its last examination, the Committee closed its supervision of the individual measures in Parascineti, Cristian Teodorescu and Atudorei.

In N., following the Court’s judgment finding that his continued psychiatric detention was arbitrary, the applicant was released from psychiatric hospital, where he had been detained for over 17 years. The authorities secured his transfer to community-based sheltered housing, suited to providing him the significant level of medical and social support, and care needed after his long confinement.

The Committee pursued its supervision, in order to make sure that the arrangements made to allow for the applicant’s release into the community remained in place as long as his situation so required.

In November 2023, the authorities informed the Committee that Mr N. had passed away
(DH-DD(2023)1378).

In R.D. and I.M.D., where the applicants had been released from psychiatric detention on the condition that they follow outpatient treatment, the Committee considered that given the legislative deficiencies underlying the violations in this judgment, their situation is linked to the general measures required to remedy these.

General measures:

A. Last examination by the Committee of Ministers (June 2023)

At that time, the execution process had long been at a standstill. Details about the Committee’ decisions and Interim Resolution CM/ResDH(2022)49 adopted in the case of N., as well as the Secretariat’s initiatives, including a high-level mission, to seek to overcome the impasse can be found in the Notes prepared for that examination (CM/Notes/1468/H46-23).

The Committee recalled its heightened concerns at the persistence of the structural deficiencies revealed by the judgments and at the prolonged failure by the authorities to take action in order to guarantee non-repetition of the violations. It noted that findings of the Romanian Ombudsperson and civil society submissions attested yet again the urgent need for remedial action. It also noted with interest some promising initiatives driven by public stakeholders and by civil society, but strongly deplored the lack of any indication that the authorities, in particular key government departments, were engaged in devising a strategic, comprehensive, and co-ordinated response to the judgments, backed up by financial provisions.

The Committee exhorted once more the authorities, at a high political level, to demonstrate the firmest determination and commitment by providing impetus, direction, and co-ordination to the action required to implement the judgments.

It strongly urged them to submit, by 30 September 2023 at the latest, a clear and precise roadmap with a tight timetable for the completion and for the adoption at the highest level of government of a comprehensive action plan to address fully and lastingly these structural deficiencies.  

It decided to resume the examination of these cases at its Human Rights meeting in March 2024 and, in the absence of significant progress towards the completion and the adoption of the required action plan, it instructed the Secretariat to prepare a draft interim resolution for consideration at that meeting.

In December 2023, the Committee decided to postpone its consideration of these cases to the present meeting (CM/Del/Dec(2023)1483/A2).

B. Developments since the Committee’s last examination

1)     Preparation and adoption by the Government of an action plan for the execution of the judgments

In their submission of 17 May 2024, the authorities announced that the Government had adopted, on 16 May 2024, an action plan for the execution of these and other judgments[2] concerning violations of rights of people with mental health conditions and/or intellectual disabilities to be implemented over the period 2024-2029 (DH-DD(2024)573).

The authorities specified that the document sets out a broad range of measures, aimed, among other things, at strengthening the institutional capacity of the mental health public policy agency, developing community-based mental health and social support services, promoting the necessary legislative interventions, improving the infrastructure and material conditions in several psychiatric establishments, strengthening the mental health workforce as well as the training and awareness-raising of relevant professionals, improving inter-institutional co-operation, and reinforcing the internal control mechanisms. It also determines the sources of financing to back up the implementation of these measures. 

The action plan, submitted to the Committee on 4 June 2024 (DH-DD(2024)635), was prepared by a working group established by the Prime Minister’s Chancellery and placed under the co-ordination of a state councillor in this office.

The working group included representatives of the relevant government departments and agencies, the presidential administration, the judiciary and the prosecution service, national human rights institutions,[3] professional associations and mental health services. It also included representatives of the Romanian NGO Centre for Legal Resources, which, over the past two years, has spearheaded consultations with relevant professionals across the country on the possible content of an action plan.[4]

In January 2024, the working group had consultations in Bucharest with staff from the Department for the Execution of Judgments on the strategic approaches and the main lines of action of the plan then under preparation. The Head of the Prime Minister's Chancellery attended part of the exchanges, which were chaired by co-ordinating state councillor. They have, among other things, allowed identifying avenues for further technical co-operation between the Romanian authorities and the Council of Europe in the next stages of the execution process.

2)     Legislative amendments

During the exchanges in Bucharest, the authorities indicated that they had amended the Mental Health Act in 2023, to authorise also psychiatric units in general hospitals to proceed to involuntary placements under this Act, if they are suitably equipped (previously, only psychiatric hospitals had such authorisation). The authorities considered that this can contribute to alleviating overcrowding in psychiatric hospitals, in addition to allowing these patients to be cared for closer to their homes and families.

In April 2024, Parliament enacted amendments to the Code of Criminal Procedure[5] in order to remedy the shortcomings identified in R.D. and I.M.D. in the provisions authorising the psychiatric detention of individuals who fail to comply with court orders imposing on them an obligation to undergo outpatient psychiatric treatment. Under the new provisions, detention is no longer automatic in such cases. The courts can now ascertain the reasons for non-compliance. Where they consider that detention might be justified, they must order a new forensic psychiatric expert assessment and decide on this basis whether to impose or not psychiatric detention. The courts must hear the person concerned. Legal assistance is mandatory and will be provided ex officio if the person concerned does not have a chosen counsel.

Latest Rule 9 communications

- Communications from the Romanian Ombudsperson (Rule 9 (2))

In June 2023, the Ombudsperson of Romania submitted a communication for the first time under the Committee of Ministers’ Rules (see DH-DD(2023)676). It announced that it would take new action to verify the situation as regards involuntary placements implemented under the Mental Health Act (Cristian Teodorescu group) in order to provide support to the execution of the relevant judgments. In a communication of 19 January 2024 (DH-DD(2024)67), the Ombudsperson announced that it had completed its review and had included its conclusions and recommendations in a special report,[6] which was published on 23 January 2024.

The report is based, among other sources, on the findings of visits carried out in the eight psychiatric hospitals and psychiatric sections in general hospitals. It notably concludes that there are still significant gaps in the application of the procedures and safeguards under the Mental Health Act by medical and justice professionals and that other structural deficiencies revealed by the judgments persist.[7] It makes detailed recommendations of remedial action, including legislative and regulatory change.

- Communication from the Council of Europe Commissioner for Human Rights (Rule 9.4)

In a communication of 6 March 2024, the Commissioner welcomed the authorities’ initiative to set up the working group tasked with preparing the action plan for the execution of these judgments and to place it under high-level co-ordination. She also positively noted recent policy and legislative developments of broader relevance to the situation of people with disabilities, as well as the improved collaboration between the authorities, national human rights institutions, and relevant NGOs.

The Commissioner emphasised the longstanding, structural nature of the dysfunctions revealed by these judgments. She called for a fundamental shift in the approach to mental health care, from coercion and institutionalisation to community-based services which respect personal autonomy, and for comprehensive, multi-sectoral measures at legislative, policy and operational levels, to achieve such a shift. This should include awareness-raising to the relevant international standards and mental health guidance, as well as measures to ensure accountability for breaches of the applicable legislation, in line with the Guidelines of the Committee of Ministers on eradicating impunity for serious human rights violations, and effective access to justice for persons in mental health settings (see for details DH-DD(2024)302).

Report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT)

The CPT carried out an ad hoc visit to Romania from 19 to 30 September 2022, which focused on the treatment of patients in psychiatric establishments and of people placed in residential social care facilities.

The CPT published its report on this visit on 5 October 2023 (CPT/Inf (2023) 28). It found that urgent action was required to ensure that patients are offered decent living conditions and appropriate treatment for their mental disorders, including reinforcing staffing levels in the psychiatric hospitals visited. It also recommended measures to ensure that all the relevant officials fully apply the legal provisions on involuntary placements in such hospitals and to enhance the safeguards attending patients’ consent to psychiatric treatment. More generally, it advocated for a shift away from institutional care towards establishing mental health services in the community and offering adequate social support structures.

The CPT found other systemic shortcomings in the treatment and care for patients with mental disorders who have offended and are subject to psychiatric detention, including the lack of legal pathways, infrastructure and services allowing for their gradual release and follow-up in the community (N. group). It called for reform and indicated the changes needed to make the current system of forensic psychiatric care fit for purpose.

Analysis of the Secretariat

Individual measures:

In N., as the applicant has passed away, no further individual measure is possible. The Committee can therefore close its supervision of this question.  

In R.D. and I.M.D., the violations stemmed from the absence of sufficient legal safeguards attending on the one hand decisions to detain individuals who fail to comply with court orders imposing on them an obligation to undergo outpatient psychiatric treatment, and, on the other hand, the administration of psychiatric medication to these patients, whilst detained.

The applicants remain subject to court orders imposing on them the obligation to undergo outpatient psychiatric treatment. The courts can order their return to psychiatric hospital if they fail to comply with these orders, subject to the safeguards recently introduced to address the first legislative gap outlined above, or if their mental health condition worsens. Their situation remains therefore linked to the adoption of the general measures required to ensure that the administration of medication to such patients is attended by the required Convention safeguards.

General measures:

For many years, the Committee has been urging the Romanian authorities to remedy the structural deficiencies revealed by these judgments in the protection of the rights of people with mental health conditions and/or intellectual disabilities involuntarily placed in psychiatric establishments.

As stressed by the Committee, including at its last examination, the deficiencies in these patients’ living conditions, treatment and care have clear humanitarian implications. Other aspects have rule of law implications, for example the authorities’ failure to observe the legal provisions and safeguards attending involuntary psychiatric placements; the non-implementation of court decisions ordering patients’ discharge; or the absence of judicial review of decisions to renew such placements in some cases or to proceed to the forcible administration of medication.

The latest reports of the Romanian Ombudsperson and of the European Committee for the Prevention of Torture have again shown that the situation on the ground entails a grave risk of repetition of the violations and requires remedial action, as a matter of urgency.

It is therefore reassuring that the authorities have now responded to the Committee’s urgent calls for action at a high political level to overcome the impasse in the execution process and have provided impetus, direction and co-ordination to the work carried out over the past year to prepare an action plan with measures to remedy these deficiencies.  

The broad range of stakeholders involved in this work, including national human rights institutions and civil society and professional organisations, merits particular mention, as it stands out as an example of co-operative and inclusive approach to the execution process.  

As a result of this new momentum, the Romanian Government has adopted a national action plan setting out wide-ranging and multi-faceted measures for the execution of these and other relevant judgments of the European Court, as also requested by the Committee.

Given its recent adoption and its complexity, a detailed assessment of the action plan cannot be made at the present examination, but it can be generally observed that its strategic approaches and lines of action go clearly in the right direction and that its endorsement by the government creates the requisite conditions for the effective and timely implementation of the remedial action it sets out.

The Committee could therefore welcome the adoption and the submission of the action plan and express satisfaction at the response given by the authorities, at the highest levels, to its above-mentioned calls.

It could request the authorities to keep it informed on a regular basis of the progress made in implementing the action plan. It could moreover invite the authorities to continue their constructive dialogue with the Secretariat, including in order to explore all other possible avenues of technical co-operation with the Council of Europe in the execution process.

The Committee could instruct the Secretariat to prepare an in-depth analysis of the measures set out in the action plan and of the further information on their implementation.

It could consider resuming its examination of these cases at one of its Human Rights meetings in the first half of 2025, in the light of this analysis and of any other relevant developments.

Financing assured: YES