O.G. v. LATVIA
Inadmissible
Guido Raimondi;Ineta Ziemele;Ledi Bianku;Nona Tsotsoria;Päivi Hirvelä;Paul Mahoney;Yonko Grozev
1. The applicant is a Latvian national, who was born in 1965 and lives in Riga. The President granted the applicant’s request for his identity not to be disclosed to the public (Rule 47 § 3). The applicant was granted permission by the President of the Section to represent himself in the proceedings before the Court. 2. At around 7 p.m. on 9 August 2012 the applicant took a trolleybus without purchasing a ticket; he attempted to purchase one only after ticket inspectors had entered the trolleybus. When they ordered him to pay a fine, he stamped on one of the ticket inspector’s feet and kicked her legs, before grabbing both inspectors by their necks. When the driver stopped the trolleybus and approached the applicant, the latter started hitting him with his umbrella. At that point the police arrived and took the applicant to the police station, where he arrived at 7.10 p.m. 3. At the police station the applicant continued behaving aggressively: he tried to attack police officers, uttered threats and said that he had robbed the President of Latvia. The police sought the assistance of the Emergency Medical Service, which took the applicant to Riga psychiatric hospital (VSIA“Rīgas psihiatrijas un narkoloģijas centrs”) at about 8 p.m. 4. At 8.25 p.m. the applicant was examined and Dr L.S. noted that he was in a state of psychomotor agitation and was “not accessible for productive contact”. He was administered appropriate medical treatment. 5. At 9 a.m. the following day, 10 August 2012, the applicant and his medical file were examined by a panel of three doctors in order to establish whether there were grounds to prescribe involuntary psychiatric treatment. None of the doctors had been involved in assessing the applicant’s state of health on 9 August 2012. 6. The applicant’s behaviour during the interview with the panel of doctors was reported as follows: “No symptoms of unclear consciousness. Not accessible for productive contact. Answers questions with counter-questions. Behaves in an expressive, defiant way. Suspicious. Asks what drugs have been given, who has allowed [him] to be given drugs without his agreement. Does not explain his actions [in the police station and against the ticket inspectors]. Denies having said that he has robbed the president. Says that “everything will be alright”. Refuses to [give consent to being treated in the psychiatric hospital]. Thinking is confused, inconsistent. Gives an impression that [he] is listening to what is happening around him. Patient is entirely under the spell of his own psychotic experiences. Complete lack of criticism [sic] towards the necessity of being treated, concerning his illness and actions.” 7. The report went on to diagnose the applicant in the following manner: “Diagnosis: F20.00 Paranoid schizophrenia – continuous course, acute phase. Hallucinatory-paranoia syndrome. ” 8. The report concluded that the applicant’s involuntary inpatient treatment in a psychiatric hospital should be continued under section 68(1) of the Medical Treatment Law. It stated that the applicant had expressed a wish to participate in the court hearing concerning his compulsory treatment. 9. The hearing took place before the Riga City Ziemeļu District Court on 13 August 2012. It was attended by the applicant, a sworn attorney, E.T., and a representative of the hospital. During the hearing the representative of the hospital maintained the proposal to order the applicant’s involuntary in-patient psychiatric treatment, referring to, among other things, the fact that the patient was “angry”, that he did not want to talk to doctors, had stated that he had killed the president, and was aggressive. She also referred to the applicant’s history of psychiatric treatment. In response to the applicant’s question as to why he had been taken to the hospital, the representative of the hospital explained to him that it was because he had “talked nonsense”. The applicant admitted that there had been a conflict in the trolleybus but denied having said that he had killed or robbed the president. He explained that he knew himself how and when he should get medical treatment, and that he had been receiving out-patient medical treatment. 10. The decision adopted by the court on 13 August 2012 referred to the applicant’s history of psychiatric treatment, noting that he had been regularly visiting a psychiatrist on an out-patient basis but had been taking the prescribed medication whenever he chose to. The decision then cited the report of the panel of doctors who had examined the applicant, summarised the oral submissions of the participants of the hearing, and decided to endorse the recommendation of the panel that the applicant should be hospitalised. In establishing that the applicant posed a danger to others, the court referred to the record of the applicant’s detention drawn up by the police on 9 August 2012. That record stated that the applicant had uttered threats, and claimed to have stolen from the President of Latvia and to have robbed several houses. 11. The court went on to note the following: “An analysis of the application [for the applicant’s involuntary treatment] confirms that it has been found that [the applicant] is suffering from a psychiatric disorder, for which he has been repeatedly treated in [a psychiatric hospital]. The symptoms of the psychiatric disorder are characterised by aggressive and conflictual behaviour, which give the court no reasons to doubt the circumstances of the patient’s behaviour [and] the reasons for his placement in the [hospital], as described in the decision of the panel and the material appended to it. Such behaviour on the part of the patient creates a real danger to the life and health of the patient himself as well as to that of other people”. 12. The court agreed with the medical panel’s conclusion that an improvement in the applicant’s health was only possible if he received in-patient treatment. In relation to the out-patient treatment, the court noted that as there was no evidence – apart from the applicant’s own statement – that he had been taking the prescribed medication, it was unable to conclude that he had a serious attitude towards the out-patient regime. The court further considered that the applicant had remained sceptical about the suggestion that he was suffering from a mental disorder and denied that he needed any treatment. In the light of those considerations, the court came to the conclusion that ordering involuntary treatment was in the best interests of the applicant. The court ordered that the applicant receive in-patient treatment for two months. 13. The applicant appealed and his appeal was examined in written proceedings by the president of the Ziemeļu District Court on 30 August 2012. In his appeal the applicant indicated that he disagreed with the interference by the psychiatric hospital in his personal life and that he did not understand in what context he had been detained. The president of the court considered that the applicant’s appeal did not contain any grounds that would put the legitimacy of the impugned decision in question. 14. The applicant was discharged from the hospital on 14 September 2012. 15. Section 67(1) of the Medical Treatment Law provides that psychiatric assistance should be provided on a voluntary basis. In-patient assistance is to be provided in a psychiatric establishment only where, owing to the state of health of the patient, such assistance cannot be provided on an out-patient basis or at the patient’s place of residence. 16. Section 68(1) provides an exhaustive list of situations in which involuntary psychiatric treatment may be administered. The first subparagraph authorises involuntary treatment in cases where “[the patient] has threatened or is threatening, has attempted or is attempting to inflict bodily injuries on himself or on another person or has been or is violent towards other persons and if a medical specialist concludes that the patient has a mental health disorder, which might result in serious bodily injury to the patient himself or to another person”. 17. The second subparagraph of section 68(1) allows involuntary treatment in cases where the patient displays an inability to take care of himself and if a medical specialist concludes that the patient has a mental health disorder which might result in an irreversible and serious deterioration of his or her state of health. 18. Section 68(3) provides that in the event that the involuntary hospitalisation of a patient is considered necessary, a panel of psychiatrists should examine the patient within seventy-two hours and adopt a decision in that regard. Pursuant to section 68(5), such a decision must be sent to the competent District Court within twenty-four hours. The District Court will then examine the decision of the panel and decide whether to approve the patient’s involuntary hospitalisation for a period of up to two months. The application for involuntary admission to a psychiatric hospital must be examined within a period of seventy-two hours after receipt of the decision adopted by the panel of psychiatrists. 19. Section 69 of the Medical Treatment Law provides as follows: “(1) If a person disrupts public order due to a mental disorder or a mental disease, that person shall be detained, transported to a psychiatrist and supervised there by the police in accordance with the Law on Police. (2) The police shall submit to the psychiatrist a written report concerning the antisocial nature of the [patient’s] behaviour”.