European laws on compulsory commitment to care of persons suffering from substance use disorders or misuse problems– a comparative review from a human and civil rights perspective

Abstract

BackgroundLaws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights.MethodsThirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted.ResultsThere are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems.ConclusionThe study raises questions concerning whether various European CCC laws in relation to substance use disorder or misuse problems comply with international ratified conventions concerning human and civil rights. This, however, applies to all three types of law, i.e. social, mental health and criminal legislation. The main differences between law types concern legal criteria, reflecting different national priorities on implicit ambitions of CCC – for correction, for prevention, or for support to those in greatest need of care.

Legality of Applying Coercive Medical Measures in Criminal Law

“…The application of such measures is rightly considered an instrument of public (in terms of protecting society and other people) and personal (in terms of protecting the person in need of treatment) security in modern society (Dos Reis and Guareschi, 2016). This step is quite justified both from the standpoint of protection of human rights and freedoms, despite the compulsion to treat people with mental disorders, drug addiction, alcoholism (Israelsson et al, 2015), and from the perspective of security (Pukavskyi and Kushpit, 2019).…”

“…Besides, European legislation also establishes the legality of compulsory medical care for persons suffering from certain diseases in terms of guaranteeing human rights (Israelsson et al, 2015). But in practice, there are often difficulties in addressing the issue of possibility and necessity of applying these measures to perpetrators (Losych and Rutvian, 2019).…”

Addictive Behavior in Immigrant Psychiatric Inpatients: The Immigrant Paradox Failure

“…dependence or abuse or harmful use of alcohol and/or drugs) or misuse problems (problematic substance use i.e. use related to medical emotional social or legal problems whether these meet diagnostic criteria of substance use disorders or not) is a fairly common legislative option worldwide (29). Particularly in Italy CCC is very well defined by legislation and it could be done only if the clinician identifies the presence of specific acute psychiatric symptoms at the moment of evaluation (30).…”

Characteristics of Psychiatric Emergency Situations and the Decision-Making Process Leading to Involuntary Admission

“…In most countries, a physician is legally enabled to mandate an IA of a patient (17, 26). As the gatekeeper to IA, the physician has a crucial role in implementing legal regulations (27) and weighing risks and benefits of involuntary care for the individual patient (28, 29).…”