Restrictions of freedom
According to the Act CLIV of 1997 on Healthcare, a patient may be restricted in exercising his/her rights only for the period of time justified by his/her state of health, and to the extent and in the way provided for by law. Among the general rules the Act on Healthcare states that the patient’s personal freedom may be restricted by physical, chemical, biological or psychological methods or procedures exclusively in case of emergency, or in the interest of protecting the life, physical safety and health of the patient or others. Medical emergency is a sudden change in health, which, in the absence of urgent medical care, would endanger the patient’s life, or result in severe or permanent health impairment. The other exception applies to the rules of coercive measures in psychiatric care. This provision also applies when a patient with a severe contagious disease is not allowed to leave the healthcare facility (due to possible endangerment of other’s health and physical safety).
The conditions for involuntary internment
If a patient manifests “immediately dangerous behaviour” because of a mental disorder or an addiction, and if the danger can be averted only by immediate admission to and treatment in a psychiatric institute, the doctor observing this behaviour shall take immediate measures to transport the patient to the proper psychiatric institute. If necessary, police shall assist in transporting the patient.
Dangerous behaviour: the patient, as a result of a disturbance in his/her mental condition, may pose a significant threat to his/her own or others’ physical well-being or health, while the nature of the disorder does not warrant urgent institutional treatment.
Immediately dangerous behaviour: the patient, as a result of an acute mental condition, poses an immediate and serious threat to his/her own or others’ life, physical well-being, or health.
The procedure for involuntary internment
Within 24 hours of admission of the patient, the person in charge of the psychiatric institute shall notify the court and initiate a court finding that there were grounds for the admission, and request a court order for mandatory treatment of the said patient in a psychiatric institute. The court shall issue a decision within 72 hours of notification. Until the court decision is rendered, the patient may be temporarily detained in the institute. The Parliamentarian Commissioner on Civil Rights released a report in April 2011 in which he stated that in some cases these deadlines, set as a guarantee, are not met in practice.
The court shall order compulsory treatment of a patient in a psychiatric institute when the said patient exhibits dangerous behaviour because of a mental disorder or an addiction, but when there is no cause for emergency treatment. The procedure for ordering compulsory treatment shall be initiated by the specialist doctor in the psychiatric institute who determines the need by notifying the court, and shall recommend the psychiatric institute where the treatment is to occur.
The court shall render a decision on ordering mandatory institutional treatment within 15 days of receipt of notification. Prior to rendering its decision the court shall hear the patient, the expert opinion of an independent forensic psychiatrist - who is not participating in treatment of the patient – who has been subpoenaed to attend the hearing of the patient, and the specialist initiating the procedure. If the patient does not appear when subpoenaed, the court may order that s/he be brought before the court.
If the court orders compulsory institutional treatment for the patient, and the patient does not appear at the psychiatric institute set forth in the order within three days of receipt of the legally binding decision, the doctor initiating the proceedings shall act to have the patient brought in. When necessary, police shall participate in the transport of the patient.
The duration and review of involuntary internment
The court shall periodically review the need for compulsory institutional treatment every 30 (inpatient care) or 60 (rehabilitation care) days.
A patient ordered to submit to compulsory treatment shall be discharged from the institute when there is no longer cause for the said treatment.
Admission into a social care home
For people who have been placed under guardianship, detention in a social care home is treated as a voluntary process. There are no established standards or procedural protections. Even though a guardianship authority may be required to approve a social care home placement, this is a purely administrative review process.
Restriction of personal liberty
Article 10 (4) of the Health Care Law of 1997 (known as CLIV which came into force in 1998) allows for the temporary restriction of a patient’s liberty during treatment with physical, chemical, biological or psychological means in case of necessity i.e. to protect the life, physical inviolability and health of the patient or other people. Such measures cannot be applied for the purpose of punishment, cannot be degrading or inhuman and can only last as long as the need exists. During the application of these measures, the patient’s needs must be monitored and recorded in his/her medical files.
Such restraint/deprivation of liberty must be ordered by a doctor who must note the reason and duration of the measure in the patient’s medical file, preferably before the measure is applied. In the absence of constant medical supervision a nurse can assign such measure but the written approval of the doctor must be obtained within 16 hours. In the absence of such approval the measure must be stopped.
The procedure for the use of coercive measures
The application of restrictive methods or procedures shall be ordered by the patient’s attending doctor. Prior to applying such coercive measures, or if it is not possible, within the shortest possible time after the initiation of their application, the attending doctor shall enter the coercive methods or procedures in the medical record, indicating precisely the reasons for and the duration of application. In the absence of continuous medical supervision, in exceptionally justified cases, a registered specialist nurse may also give temporary order for the restriction. The attending doctor shall be informed of the restriction without delay, and shall be required to approve it in writing within sixteen hours. In the absence of such approval, the restriction must be terminated. If restrictive methods and measures are applied, the patient’s condition and physical needs shall be observed regularly, in compliance with professional rules. The observation and the findings shall be entered into the patient’s medical records.
The Act on Healthcare regulates involuntary treatment and coercive measures that can be applied to psychiatric patients in a separate chapter. According to the definition, people with dementia can fall under the term of psychiatric patients. Psychiatric patients are those who are diagnosed under F00-F99 or X60-X84 according to the International Classification of Diseases.
The rights of a psychiatric patient as set forth under the general rules on patients’ rights shall be restricted, while receiving healthcare services, only in keeping with the specifications of the Act on Healthcare, and only to the degree and for the duration of time absolutely necessary, and only if the patient’s behaviour qualifies as dangerous or immediately dangerous. However, the right to human dignity shall not be restricted, even in this case.
The duration of the use of coercive measures
Only a patient who exhibits dangerous or immediately dangerous behaviour shall be restricted in his/her personal freedom in any manner whatsoever. The restriction shall only be maintained, and shall only be employed to the extent and in the manner that is absolutely necessary to avert the danger. The general rules explained above on coercive measures shall be applied in ordering restraints and in the mode of restriction. The doctor shall immediately be notified of the restriction, and said doctor shall have to approve the measure within 2 hours. If this is not forthcoming, the restriction shall be immediately terminated. During the course of the coercive measure the condition of the patient shall be monitored continuously.
The Act on Healthcare defines three types of psychiatric treatment: voluntary, emergency and compulsory. The court shall review the necessity of the treatment periodically (in every 30 or 60 days) in the case of voluntary treatment as well. A patient admitted voluntarily shall not be discharged if in the course of treatment s/he displays dangerous or immediately dangerous behaviour and the need for institutional treatment exists for that reason.
The use of coercive measures in social care homes
If someone exhibits dangerous or immediately dangerous behaviour in a social care home, the coercive measures can be applied according to the chapter on psychiatric patients in the Act on Healthcare. The attending doctor is the doctor of the social care home, if the said doctor is not available, the head of the social care home shall appoint a registered nurse to enter the restrictive measures. In this case, the head and the doctor of the social care home shall be informed without delay. The head of the social care home shall inform within 48 hours the legal representative of the patient and the clients’ rights representative about the restrictive measures taken.
The above information was taken from the report “Human Rights and Mental Health: Hungary (1997).
Coercive measures to make a person change his/her decision
A patient or person who has refused life-saving or sustaining treatment in accordance with Article 22 of the Act CLIV of 1997 on Health Care during the rejection of the treatment cannot be coerced to change his or her decision.
According to the Hungarian Civil Liberties Union’s (HCLU) survey conducted in 2002, there are serious violations of law and human rights in the area of measures restricting the liberty of psychiatric patients. (Patient Rights in Hungary – Rules and Practice, Published by HCLU, 2002 January, Budapest)
Article 59 of Act IV of 1978 on the Criminal Code does not specifically refer to dementia but covers the prohibition from driving vehicles of people who are not fit to drive. It states:
Prohibition from driving vehicles shall be of definitive effect or shall be of definite duration. Such person may be prohibited with definitive effect, who is unsuitable for driving vehicles. The shortest duration of prohibition of definite duration shall be one year, its longest duration shall be ten years.
Article 18 and 19 of Act LXIX of 1998 on the Summary Offenses also names the prohibition from driving vehicles as a possible action to be taken in case of committing the offense while breaking the rules of driving vehicles. The shortest duration shall be one month, the longest shall be one year. However, the prohibition from driving vehicles cannot be of definitive effect in this case.
Rosenthal, E., Okin, R., Bauer, E. et al. (1997), Human Rights and Mental Health: Hungary, Mental Disability Rights International, Accessed online on 11 October 2011 at: http://www.disabilityrightsintl.org/wordpress/wp-content/uploads/Hungary.pdf
Last Updated: mercredi 14 mars 2012