Professional Documents
Culture Documents
CASE OF X v. RUSSIA
JUDGMENT
STRASBOURG
20 February 2018
This judgment will become final in the circumstances set out in Article 44 § 2 of the
Convention. It may be subject to editorial revision.
X v. RUSSIA JUDGMENT 1
PROCEDURE
1. The case originated in an application (no. 3150/15) against the
Russian Federation lodged with the Court under Article 34 of the
Convention for the Protection of Human Rights and Fundamental Freedoms
(“the Convention”) by a Russian national, Mr X (“the applicant”), on
30 December 2014. The President of the Section acceded to the applicant’s
request not to have his name disclosed (Rule 47 § 4 of the Rules of Court).
2. The applicant, who had been granted legal aid, was represented by his
father Mr Y.P., who had been granted leave to present the applicant’s case
by the President of the Section under Rule 36 § 4 (a) of the Rules of Court.
The Russian Government (“the Government”) were represented initially by
Mr G. Matyushkin, the Representative of the Russian Federation to the
European Court of Human Rights, and then by his successor in that office,
Mr M. Galperin.
3. The applicant alleged that his involuntary placement in a psychiatric
facility had been unlawful in the light of the failure of the national
authorities to meet the substantive requirements for involuntary
hospitalisation and the procedural defects in the judicial authorisation of his
hospitalisation.
4. On 13 May 2015 the application was communicated to the
Government.
2 X v. RUSSIA JUDGMENT
THE FACTS
condition improved. He continued his studies. In the past year he has started paying
more attention to his appearance, using lipstick, wearing women’s jewellery, [and
has] sometimes tried on women’s clothing at home. He became acquainted with a
boy, a ninth grade student, during one of his walks in the city. He started meeting
him, talking to him, tried to ‘have physical contact’, touched his hand, fondled it.
Had a desire to be ‘caressed’.
According to the supporting documents – [a report to the head of the police
station, the order for a psychiatric ambulance] – he was apprehended by police
officers on the street, where he had been sexually harassing an underage teenager,
having stalked him for four months, repeatedly not allowing him to walk away from
such encounters. Transferred to [the police station] where he was examined by a
psychiatrist on duty, subsequently involuntarily admitted [to the psychiatric
hospital] ... During his examination in the reception ward he signed [a document
consenting] to treatment ...
Psychiatric state: Self-aware. Subdued mood. Somewhat distracted. Looks untidy,
unkempt hair, dyed ginger. Soft, high-pitched voice. Indisposed to conversation,
replies [only] after some pause, does not answer certain questions, asks for some
questions to be repeated. While replying he gulps with an expression of pain.
Excessive facial expressions during conversation. States that he feels uncontrollable
attraction to boys, to be liked by them, to have contact with them. Requests a “space
to meet with a boy”. Blushes while saying this. Considers himself a “female
person”. Considers in-patient treatment necessary for himself in order to improve his
mood, reduce irritability and “perplexity of thoughts”. Denies hallucinations. Denies
suicidal thoughts.
Diagnosis: Schizotypal disorder.”
12. On the same day the applicant, after conferring with his father,
demanded to be discharged from the Hospital; however, his request was
denied.
13. On the same day a medical counselling panel composed of the
resident psychiatrists of the Hospital examined the applicant and diagnosed
him with organic delusional disorder. The panel also found that the
applicant was a danger to himself and others and that there was a risk of
significant damage to his health due to the deterioration or aggravation of
his psychiatric condition in the absence of psychiatric assistance. The full
text of the panel’s report and conclusion read as follows:
“25.04.2014 12.00 Panel examination due to refusal of treatment.
Lethargic, sluggish. Subdued mood. Attributes [the cause of] his subdued mood to
[his] inability to meet up with a boy he is attracted to. Unsure whether that boy also is
attracted to him. Goes across the city to see that ‘boy’. He wants to be ‘treated gently,
to be caressed, fondled’. Admitted that he goes to women’s clothing stores [because
he likes the clothing], which is ‘soft and bright’. For a long time has been visiting the
neighbourhood where he met the boy; previously he had been going to other
neighbourhoods to watch boys.
Diagnosis: Organic delusional disorder.
Conclusion: needs involuntary placement and treatment, in accordance with section
29(a) and (c) of the 1992 Psychiatric Assistance Act.”
4 X v. RUSSIA JUDGMENT
14. On the same day the Hospital applied for judicial authorisation of the
applicant’s involuntary hospitalisation under section 29(a) and (c) of the
Psychiatric Assistance Act 1992, since the applicant was a danger to himself
or others and there was a risk of significant damage to his health owing to
the deterioration or aggravation of his psychiatric condition in the absence
of psychiatric assistance. The application restated the findings of the earlier
joint examination (see paragraph 11 above) and set out the following
conclusions:
“On 25 April 2014 was examined by the panel of resident psychiatrists of [the
Hospital] and diagnosed with organic delusional disorder.
The patient needs to be involuntarily hospitalised and treated under section 29 (a)
and (c) of the Psychiatric Assistance Act of 1992.
The examination and treatment of the patient can take place only under an in-patient
regime ...
[It is requested]
1. [That authorisation be granted for the applicant’s involuntary placement in a
psychiatric facility];
2. That the request for authorisation be assessed on the premises of the Hospital,
since because of his mental state [the applicant] cannot be produced in court ...”
15. On 5 May 2014 the Savyolovskiy District Court of Moscow
(Савёловский районный суд г. Москвы) held a hearing on the premises of
the psychiatric facility. The hearing was attended by the applicant, his father
and mother, the attending psychiatrist Mr P., the head of one of the
Hospital’s departments (Mr L.), the representative of the Hospital (Mrs K.)
and the local prosecutor.
16. During the hearing Mr P., Mr L., and Mrs K. generally advanced the
same arguments as those presented in the application for judicial
authorisation (see paragraph 14 above), maintaining that the applicant
needed to be hospitalised and treated, that he posed a danger to himself and
others, and that there was a risk of significant damage to his health in the
event of a deterioration in or aggravation of his psychiatric condition in the
absence of psychiatric assistance. Mr P. also reported that the applicant
considered himself to be healthy and refused treatment, while at the same
time “being confused, replying to questions with other questions, and being
exceptionally insincere”. They also emphasised the fact that the applicant
had been apprehended by the police for sexually harassing an underage
person.
17. The applicant’s parents had conflicting opinions about the need for
hospitalisation. The mother stated that the applicant did “not feel well” and
had been “irritable lately”, that her communication with him was restricted
by the father and that she had not seen him since 10 February 2014. In her
opinion, in-patient treatment was necessary. The applicant’s father, acting as
his representative, objected to involuntary hospitalisation and did not agree
X v. RUSSIA JUDGMENT 5
that his son posed any danger to himself or to others. He stated that Mr X
was voluntarily following the treatment prescribed by a neurologist and a
psychiatrist, that his condition showed signs of improvement and that
hospitalisation would interfere with his studies and future career. In his
opinion his son had only tried to become friends with “the boy”, not
sexually harass him. He furthermore stated that the police report referred to
by the Hospital contained no information on the alleged sexual harassment
or other unlawful acts.
18. The applicant stated the following during the hearing:
“I refuse treatment and feel myself to be well ... There is nothing special about me.
I dyed my hair ginger because that colour suits me, I do not like black. I only
wanted to become friends with that boy, nothing special; I tried no clothes on; that is
all nonsense. [I want to finish my studies]; I have only two months left and I do not
want to be in hospital. I made no statements concerning trying on womens’ clothing
or changing gender.”
19. The District Court, having considered the above-mentioned
statements, medical evidence, a police report, and the applicant’s
educational records, the same day authorised the applicant’s involuntary
hospitalisation. The authorisation issued by the court in a succinct manner
stated that, while the applicant and his father objected to hospitalisation, the
evidence presented by the medical panel of the Hospital demonstrated that
the applicant was a danger to himself and others and that his mental state
might deteriorate in the absence of treatment.
20. The applicant’s father appealed. The statement of appeal indicated
that the District Court had relied exclusively on the evaluation of the
resident psychiatrists, had not addressed inconsistencies in evidence, had
failed to substantiate the assertion that the applicant’s condition was severe
and that he posed a danger to himself or others, and, lastly, had failed to
demonstrate the absence of any alternative treatment options.
21. On 20 May 2014 the applicant was discharged from the Hospital
after an improvement in his mental state.
22. Certificates issued by the local police station in May 2014 stated that
the applicant had not committed any administrative or criminal offence and
that he had been referred to psychiatrists because of mental disorders.
23. On 18 July 2014 the appeal was dismissed by the Moscow City
Court (Московский городской суд). The relevant parts of the decision read
as follows:
“... The case file shows that on 24 April 2014 [a policeman apprehended the
applicant]. The police report indicates that [he] had been harassing underage
persons ...
Since the behaviour of [the applicant] exhibited symptoms of mental disorder, [he
was taken to the Hospital], where he initially agreed to hospitalisation, stated that
since 2013 [he had been subject to] mood changes, and that he [suffered from]
anxiety, irritability and difficulties in focusing his attention. Previously he had been
hospitalised in [a psychiatric facility]; following his discharge from [that facility] his
6 X v. RUSSIA JUDGMENT
mental state improved, [and] he had continued his studies. However during the last
year the condition re-appeared.
[According to the medical evidence] on 25 April 2014 [the applicant] was lethargic,
sluggish, and had a subdued mood, which he attributed to his inability to meet up with
a boy he is attracted to.
During the hearing the representative of [the Hospital] stated that [the applicant] had
been brought in in a delusional state, and had talked about ‘a boy’ who did not [in
fact] exist. In this state he had been travelling long distances, presenting a danger to
himself and others ...
The evidence [submitted to the first-instance court] substantiating the need for
involuntary hospitalisation – including information on previous treatment for his
delusional disorder and somatic condition (a second-degree disability) – constituted
legal grounds for involuntary hospitalisation.
Since the reaching of conclusions regarding the mental health of a person is within
the exclusive competence of psychiatrists, the [district] court reasonably gave due
regard to the report on the need to provide in-patient treatment to [the applicant] ...
The appeal does not refer to any factual information demonstrating that the relatives
of [the applicant] or other persons are capable of ensuring his and other persons’
safety without an in-patient treatment regime ...”
24. The applicant’s subsequent attempts to initiate a review of the
above-mentioned judicial decisions proved unsuccessful.
THE LAW
A. Admissibility
28. The Court notes that this complaint is not manifestly ill-founded
within the meaning of Article 35 § 3 (a) of the Convention. It further notes
that it is not inadmissible on any other grounds. It must therefore be
declared admissible.
B. Merits
weighty reasons” can justify a restriction of their rights (see Alajos Kiss
v. Hungary, no. 38832/06, § 42, 20 May 2010, and Zagidulina, cited above,
§ 52). In that regard the Court reiterates that the detention of an individual is
such a serious measure that it is only justified where other, less severe
measures have been considered and found to be insufficient to safeguard the
individual or public interest (see Karamanof v. Greece, no. 46372/09, § 42,
26 July 2011, with further references).
33. In the present case, the parties did not dispute that the applicant’s
involuntary placement in a psychiatric facility had entailed a deprivation of
liberty.
34. In Winterwerp v. the Netherlands (24 October 1979, § 39, Series A
no. 33), the Court set out three minimum conditions which have to be
satisfied for the “detention of a person of unsound mind” to be lawful within
the meaning of Article 5 § 1 (e): except in emergency situations the
individual concerned must be reliably shown to be of unsound mind – that is
to say a true mental disorder must be established before a competent
authority on the basis of objective medical evidence; the mental disorder
must be of a kind or degree warranting compulsory confinement; and the
validity of continued confinement depends upon the persistence of such a
disorder.
35. The Court has also consistently held that the notion of “lawfulness”
in the context of Article 5 § 1 of the Convention may have a broader
meaning than in the national legislation and that it presumes a “fair and
proper procedure”, including the requirement “that any measure depriving a
person of his liberty should issue from and be executed by an appropriate
authority and should not be arbitrary” (ibid., § 45). In that context the
domestic proceedings must themselves offer the applicant sufficient
protection against a potentially arbitrary deprivation of liberty (see
Shtukaturov v. Russia, no. 44009/05, § 113, 27 March 2008).
36. The parties, while disagreeing on various aspects of the procedure
which had resulted in the applicant’s involuntary hospitalisation, did not
dispute that the proceedings had been secured by certain basic procedural
safeguards of the Russian legislation aimed at precluding arbitrariness.
Specifically, unlike in certain cases previously considered by the Court, the
domestic authorities complied with the prescribed time-limits for various
procedural stages (contrast Ruslan Makarov v. Russia, no. 19129/13,
§§ 28-30, 11 October 2016), the applicant was present at the hearing and
was given an opportunity to present his position (see Zagidulina, cited
above, §§ 61-62) and he benefited from representation by his father, who
also advanced arguments against the hospitalisation (see Mifobova
v. Russia, no. 5525/11, §§ 60-61, 63-64, 5 February 2015).
37. In the present case the Court does not find itself compelled to
examine in detail the procedure in respect of the judicial authorisation of the
X v. RUSSIA JUDGMENT 9
report nor the record of the joint examination in the Hospital referring to
“sexual harassment” provided a detailed account of any relevant events,
specific behaviour or utterances. At the same time the certificates issued by
the local police station clearly stated that the applicant had committed no
criminal or administrative offence (see paragraph 22 above). Under these
circumstances the courts should not have confined themselves to a
reiteration of the above allegations, but should have engaged in independent
scrutiny of whether the applicant indeed posed any real danger to anyone.
The fact that the applicant, in pursuit of his desires, travelled to another
district of the city could hardly be considered as an indication of him being
a danger to himself.
42. The Court notes that all of the above medical reports characterised
the applicant as anxious, irritable, secretive, feeling low, distracted,
confused, insincere, reserved, tense. None of these characteristics – in the
absence of evidence or indications of verbal or physical aggression,
self-mutilation, suicide, etc. – suggests that the applicant poses a danger to
anyone. It must be further noted that all the applicant’s medical records paid
detailed attention and attached decisive importance to the applicant’s
change of hair colour, his interest in women’s clothes, jewellery, and
make-up, and his desire to be fondled and caressed and “to spend time with
boys”. It is not for the Court to express an opinion on whether these aspects
of the applicant’s life, taken alone, can be said to demonstrate the existence
of any mental disorder; however, in any event it does not find them as such
to constitute compelling proof that the applicant posed a danger to anyone.
43. As regards the second ground for the applicant’s hospitalisation, the
Court observes that the available medical evidence and judicial decisions
contain no explanation whatsoever of why and how the applicant’s mental
state might have significantly deteriorated in the absence of involuntary
inpatient treatment.
44. In the Court’s opinion neither the unspecified risks to the applicant’s
mental health, nor the long journeys across the city, nor the repeated
attempts to establish either friendly or romantic relationships were capable
of proving that the applicant’s condition was of “a kind or degree”
warranting compulsory confinement. The medical professionals and the
domestic courts adduced no sufficient and reliable evidence for their
decision to hospitalise the applicant against his will.
45. Given the above-mentioned conclusion the Court does not find it
necessary to examine whether the validity of the applicant’s continued
confinement depended upon the persistence of a disorder.
46. There has accordingly been a violation of Article 5 § 1 of the
Convention.
X v. RUSSIA JUDGMENT 11
A. Damage
55. The applicant, who was granted legal aid, did not submit a claim for
costs and expenses. Accordingly, the Court considers that there is no call to
award him any sum on that account.
C. Default interest
56. The Court considers it appropriate that the default interest rate
should be based on the marginal lending rate of the European Central Bank,
to which should be added three percentage points.
12 X v. RUSSIA JUDGMENT
4. Holds
(a) that the respondent State is to pay the applicant, within three months
from the date on which the judgment becomes final, in accordance with
Article 44 § 2 of the Convention, EUR 7,500 (seven thousand five
hundred euros), plus any tax that may be chargeable, to be converted
into the currency of the respondent State at the rate applicable at the date
of settlement, in respect of non-pecuniary damage;
(b) that from the expiry of the above-mentioned three months until
settlement simple interest shall be payable on the above amount at a rate
equal to the marginal lending rate of the European Central Bank during
the default period, plus three percentage points;