The imprisonment of a convicted felon for homicide, in a prison clinic in cruel conditions and without treatment, constitutes inhuman and degrading treatment. State’s obligation to establish appropriate institutions..
JUDGMENT
Strazimiri v. Albania 21.1.2020 (no. 34602/16)
SUMMARY
The case ) concerned the detention of a man, who had been exempted from criminal responsibility on account of mental illness, in a prison rather than
a medical institution. The European Court of Human Rights held, unanimously,
that there had been: a violation of Article 3 (prohibition of inhuman or degrading treatment) of the European
Convention on Human Rights because of inadequate living conditions in the prison hospital where
Mr Strazimiri was detained and insufficient psychiatric care, and violations of Article 5 §§ 1, 4 and 5 (right to liberty and security/ right to have the lawfulness of
detention decided speedily by a court/enforceable right to compensation), in particular because of
his continued deprivation of liberty in a prison rather than a medical institution and because his
appeal against his detention had been pending before the Supreme Court since 2016.
The Court found in particular that there had been a longstanding failure by the Albanian authorities
to set up a special medical institution for the mentally ill who were deprived of their liberty on the
strength of court-ordered compulsory treatment. That was in breach of its domestic statutory
obligations, and pointed to a structural problem.
It also held under Article 46 (binding force and implementation) that the authorities should not only
ensure that Mr Strazimiri received psychotherapy, not just drugs, but also create an appropriate
institution for those in his situation.
PROVISIONS
Article 3
Article 5§1
Article 5§4
Article 5§5
Article 46
PRINCIPAL FACTS
The applicant, Arben Strazimiri, is an Albanian national who was born in 1973. He has been detained
since 2011 in Tirana Prison Hospital.
Mr Strazimiri was arrested in 2008 for attempted premeditated murder, but the Tirana District Court
found that he could not be held criminally accountable for his actions because of paranoid
schizophrenia and ordered compulsory inpatient treatment in a medical institution. He was first sent
to Kruja Prison in 2009 and then transferred to Tirana Prison Hospital in 2011.
Since then the domestic courts have reviewed Mr Strazimiri’s situation on several occasions, finding
that he was still a danger to himself and to others and that his family were not capable of providing
the appropriate conditions to look after him if he were released. The courts therefore ordered his
continued compulsory inpatient treatment in a medical institution, which chiefly consists in him
taking psychotropic drugs.
He challenged his continued detention in court in 2014, arguing that, since he was neither a convict
nor detained pending trial, his placement in a penal institution was contrary to domestic law and
that he should be held in a special medical institution, as ordered by the courts. He also complained
that his medical treatment and the conditions of his detention were inadequate. Both complaints
were dismissed as manifestly ill-founded. His appeals against those decisions have been pending
before the Supreme Court since April 2015 and January 2016.
Similar complaints to the prosecuting authorities have also been unsuccessful.
Both the courts and the prosecuting authorities found in particular that until such time as specialised
institutions for mentally ill individuals who were exempted from criminal responsibility and were
subject to court-ordered medical treatment had been built, it was not contrary to the law for them
to be placed in an establishment which had been adapted to their needs, such as the special wing of
Tirana Prison Hospital.
THE DECISION OF THE COURT…
Article 3 (inadequate conditions of detention and medical care)
The Court took note of reports between 2015 and 2019 by the People’s Advocate’s Office
(Ombudsman) and the European Committee for the Prevention of Torture and Inhuman or
Degrading Treatment or Punishment (“the CPT”) which had found Tirana Prison Hospital to be in an
advanced state of dilapidation, with widespread damp and practically no central heating. Indeed, the
CPT had recently reported that those conditions had further deteriorated. Mr Strazimiri, detained in
the hospital since 2011, has been directly affected by the overall decline in the institution.
Furthermore, although he had been continuously treated with a course of medication for his mentalhealth problems, he had had no individual treatment plan, including psychiatric care. At least since 2014 the CPT had described many psychiatric patients such as Mr Strazimiri as being in a state of
“therapeutic abandonment”.
Moreover, in the face of Mr Strazimiri’s complaints, both the domestic courts and the prosecuting
authorities had even acknowledged that there were no special medical institutions for the mentally
ill who had been ordered to have compulsory treatment by the courts.
The Court considered that the cumulative effect of the deteriorated living conditions in Tirana Prison
Hospital and insufficient psychiatric care had amounted to inhuman and degrading treatment. There
had therefore been a violation of Article 3 of the Convention.
Article 5 § 1 (continued deprivation of liberty)
The parties did not dispute that Mr Strazimiri’s confinement had been a measure covered by
Article 5 § 1. In particular, there was no evidence to call into question the authorities’ conclusions
that his mental-health problems had made him dangerous and that he had required compulsory
medical treatment.
However, he had been detained in a prison hospital since 2011, which was a penal facility and not
part of an integrated health system. The CPT had repeatedly criticised placing “persons of unsound
mind” who had been exempted from criminal responsibility in penal facilities, while the People’s
Advocate had observed that such a practice was in breach of domestic law.
In addition, the authorities had repeatedly limited themselves to finding that Mr Strazimiri’s family
had not been capable of providing appropriate conditions to look after him, without considering any
alternative, such as placing him in a civilian mental health facility.
The Court was also not convinced that he had been provided with appropriate psychiatric care. His
treatment had chiefly relied on psychotropic drugs, and there had only been one psychiatrist for 84
patients in Tirana Prison Hospital.
The Court accordingly considered that Mr Strazimiri’s continued deprivation of liberty had not been
lawful, in breach of Article 5 § 1.
Article 5 § 4 (right to have the lawfulness of detention decided speedily by a court)
Mr Strazimiri had started legal proceedings against his detention in 2014 and obtained a decision in
2015, which he had appealed to the Supreme Court. There was nothing to suggest that he had
caused any delays in those proceedings, which had been pending for more than three years before
the Supreme Court. The Government, on the other hand, had not provided any reasons for such a
delay. The Court therefore found that the delay was entirely attributable to the authorities and
considered that it was not compatible with the “speediness” requirement of Article 5 § 4.
Article 5 § 5 (enforceable right to compensation)
The Court found that Albanian legislation did not provide for a right to compensation for unlawful
detention of individuals in Mr Strazimiri’s specific situation. Nor had the Government submitted any
domestic case-law to prove otherwise. It therefore concluded that the applicant had not had an
enforceable right to compensation, in violation of Article 5 § 5.
Article 46 (binding force and implementation)
The Court held that the authorities should as a matter of urgency ensure that the applicant receive
individualised therapy and consider placing him in an alternative setting, outside a penal facility.
It also considered that Albania should take measures as soon as possible to provide appropriate
living conditions and adequate health care to mentally ill persons who were subject to deprivation of liberty because of the courts ordering their compulsory medical treatment. Such measures should include either refurbishing existing facilities or creating new specialised facilities whose purpose was
to cure or alleviate the mental health of detainees, reduce their dangerousness and facilitate their
reintegration into society. Pharmacological treatment should be combined with psychotherapy, as
part of an individualised treatment plan in respect of each detainee. Lastly, the authorities should
recruit sufficient qualified mental health care workers in such facilities and consider, where
appropriate, the possibility of outpatient treatment.
Other Articles
The Court found that it was not necessary to examine separately Mr Strazimiri’s complaints under
Article 13 in conjunction with Article 3 or under Article 14 in conjunction with Articles 3 and 5.
Article 41 (just satisfaction)
The Court held that Albania was to pay the applicant 15,000 euros (EUR) in respect of non-pecuniary
damage and EUR 2,500 in respect of costs and expenses.
