Long-term detention in a psychiatric institution without the required medical care constitutes degrading treatment
Rooman v. Belgium 18-07-2017 (no. 18052/11)
The case concerned proceedings brought by Mr Rooman on account of the lack of psychiatric care in the facility in which he was being detained. The Court found in particular that the national authorities had not provided adequate care for the detainee because of the lack of care staff who could speak German, the only language he knew and one of Belgium’s official languages. It held that Mr Rooman, who had been detained for 13 years without appropriate medical support or any realistic prospect of change, had been subjected to distress of an intensity exceeding the unavoidable level of suffering inherent in detention. The Court observed, however, that there was still a link between the reason for Mr Rooman’s detention and his mental illness. The lack of appropriate care was due to factors unconnected with the nature of the institution itself.
The applicant, René Rooman, is a Belgian and German national who was born in 1957 and is detained in a social protection facility in Paifve (Belgium).
In 1997 Mr Rooman was convicted of theft and sexual assault. While in detention he committed further offences. On 16 June 2003 the Liège Court of First Instance ordered his detention in a psychiatric institution. On 21 January 2004 Mr Rooman was admitted to the Paifve facility.
Mr Rooman made an initial application for release on a trial basis. On 27 January 2006 the Mental Health Board recommended finding an institution that could admit him and provide him with therapy in German, the only language he could understand and speak. After various reviews of his situation, the Mental Health Board rejected his application for release on 26 January 2007, noting that there was no institution that could meet the security and language requirements in his case.
On 13 November 2013 Mr Rooman applied for release for the third time. In January 2014 a report from the Paifve social protection facility observed that he did not speak French and had very little contact with his fellow patients and with staff. The report concluded that he should remain in detention, citing among other reasons his “untreated mental health problems”. The Mental Health Board rejected Mr Rooman’s application for release on a trial basis, finding that the requirements of an improvement in his mental state and guarantees for his social rehabilitation were not met and pointing out that “the mere fact that he only speaks German does not mean that the Paifve social protection facility has not taken all the necessary steps to provide him with the care his condition requires.” The Higher Mental Health Board upheld that decision. In June 2014 the Court of Cassation quashed the decision of the Higher Mental Health Board on the grounds that it had not addressed the applicant’s argument that he was not receiving care appropriate to his situation, in view of the fact that he spoke and understood only German and that no German-speaking staff members were available in the facility where he was being held. The case was sent back to the Higher Mental Health Board, which on 22 July 2014 requested the Mental Health Board to appoint a panel of Germanspeaking experts to provide an update of the expert psychiatric report issued in January 2009. It also instructed the head of the Paifve facility to take all the necessary measures to ensure that the requisite care was made available, by at least providing the services of a German-speaking psychiatrist and psychologist.
In parallel with these appeals, Mr Rooman also started proceedings against the Belgian State. On 10 October 2014 the urgent-applications judge found that there had been a breach of his right of access to health care and that his situation amounted to inhuman and degrading treatment. The judge ordered the Belgian State to appoint a German-speaking psychiatrist and medical auxiliary and to provide Mr Rooman with the care routinely provided to French-speaking detainees.
Lastly, Mr Rooman filed a negligence claim against the Belgian State. On 9 September 2016 the French-language Brussels Court of First Instance found the State liable for negligence and ordered it to pay Mr Rooman 75,000 euros (EUR) in compensation to the applicant.
THE DECISION OF THE COURT
The Court noted that all the evidence before it tended to show that the main, if not the only, reason for the failure to provide therapeutic care for Mr Rooman’s mental health problems was that communication was impossible between the medical staff and the patient. In several reports the Mental Health Board and the professionals who had met Mr Rooman had confirmed that the provision of therapy had been impeded by the language barrier and that the patient’s lack of progress resulted from the absence of such care. The president of the Brussels Court of First Instance, and later that court itself, had also noted that it was the lack of therapy in German that had restricted practical access to the care that was normally available. Although Mr Rooman had been able to meet qualified German-speaking staff, this had been in a non-therapeutic context, except in the case of a German-speaking psychologist who had visited the facility to see him between May and November 2010.
The Court did not underestimate the efforts made by the mental health bodies to find a solution in Mr Rooman’s particular case. However, those efforts had been thwarted by the authorities’ failure to take appropriate measures to bring about a change in his situation. Not until the decision of the Higher Mental Health Board and the order by the president of the Brussels Court of First Instance in 2014 had the practical measures recommended for years been taken through the provision of a German-speaking psychologist, although this arrangement had ended in 2015.
Taking into account the fact that German was one of the three official languages in Belgium, the Court found that the national authorities had not provided adequate care for the applicant’s condition. His continued detention in the Paifve social protection facility for 13 years without appropriate medical support or any realistic prospect of change had entailed particularly acute hardship, causing him distress of an intensity exceeding the unavoidable level of suffering inherent in detention. Whatever obstacles Mr Rooman might have created through his own behaviour, the Court considered that this did not release the State from its obligations towards him.
The Court concluded that Mr Rooman had been subjected to degrading treatment on account of his continued detention in the conditions examined during the period from his admission to the Paifve social protection facility on 21 January 2004 until the present day, apart from two periods when he had access to a German-speaking psychologist, from May to November 2010 and from July 2014 to the end of 2015.
There had therefore been a violation of Article 3 of the Convention.
Article 5 § 1
The Court observed that Mr Rooman was being detained in a social protection facility that in principle was appropriate to his mental health condition and his degree of dangerousness. Under Article 3 it had found that he had not been provided with appropriate care and had been held in unsuitable conditions for 13 years, in breach of Article 3 of the Convention.
The Court noted that it had consistently held that as long as a person’s detention as a mental health patient took place in a hospital, clinic or other appropriate institution, the adequacy of the treatment or regime was not a matter for examination under Article 5 § 1 of the Convention.
The Court pointed out that there was still a link between the reason for Mr Rooman’s detention and his mental illness. The failure to provide appropriate care, for reasons unconnected with the actual nature of the institution in which Mr Rooman had been held, had not broken that link and had not rendered his detention unlawful.
There had therefore been no violation of Article 5 § 1.
Just satisfaction (Article 41)
The Court held that Belgium was to pay the applicant EUR 15,000 in respect of non-pecuniary damage. Separate opinion Judge Karakaş expressed a separate opinion, which is annexed to the judgment(echrcaselaw.com editing).