Table 1.

Legislations, criteria, and procedures in Europe.

Country	Legislation	Diagnosis	Other criteria	Proposal	Validation	Duration	Ability to appeal
England and Wales	Mental Health Act 1983, amended in 2007; The Welsh Mental health code of practice	Any disorder and disability of mind	The mental disorder requires detention for assessment; detention in the interest of health and safety of patient and others; available appropriate medical treatment	Relatives or professionals; police (emergency)	Two registered medical practitioners with written recommendations (non-emergency); a mental health professional and a doctor (emergency)	Admission for assessment: 28 days; for treatment: 6 months renewable once for another 6 months	Yes; mental health review tribunal
Northern Ireland	Mental Health Order 1986, amended in 2018	Mental disorder as “mental illness, mental handicap or any other disorder or disability of mind”	The mental disorder requires detention for assessment; failure to detain would create serious physical harm to patient and others	The nearest parent or an approved social worker; application for assessment shall be accompanied by medical recommendation	Responsible medical officer for assessment	Assessment: 2 days; detention for medical treatment: 6 months renewable of 6 months; then further periods of 1 year	Yes; mental health review tribunal
Scotland	Mental health Act 2015 amended the MHA (care and treatment) 2003	Mental disorder	Medical treatment available; significant risk for the health and safety of patient and others; impaired ability to make decisions; requires treatment	Two medical practitioners; mental health officer	Tribunal hearing persons who have opportunity to make representations, of leading and producing evidence	6 months renewable for 6 months twice; subsequent further reviews: 12 months	Yes; patient’s responsible medical officer
Italy	Law 180 incorporated in Law 833 of 1978	Mental condition requiring urgent treatment	The person does not accept the treatments; it is not possible to take appropriate extra hospital measures	Two physicians	The mayor and authorized by the tutelary judge who is entrusted with the jurisdictional safeguard of such treatment	7 days; renewable several times at the request of the psychiatrist to the mayor	Yes; competent court
Spain	Ley de Enjuiciamiento Civil of 8 January 2000, Book IV, Title I. Chapter 2 art. 763	Psychological disturbance, which causes inability to take decision and care for oneself	–	Psychiatrist	Judge	–	Yes
Portugal	Law 36/98 and decree 35/99, which regulates the law	Person with severe psychic anomaly	Danger to themselves or others, and refuses to submit to necessary medical treatment	Legal representative; public health authorities; the Public Prosecution Service; doctors; the clinical director of an institution (if in the course of a voluntary admission)	Judge	Least restrictive possible	Yes
Greece	(Law 2071/1992 (hospitalization. 123/A/1992): Modernization and health system organization. Articles 94–100: involuntary hospitalization and treatment The enforcement of Law 2071/92 for Involuntary Hospitalization of Psychiatric Patients. 504: Interpretative Circular of the Supreme Court of Appeal (1996)	Diagnosis of a severe mental disorder, takes into account the patient’s need for treatment and their dangerousness	Inability to judge one’s own health interest; if the nonadmission could lead to ineffective treatment or aggravation of the disease Dangerousness criteria are sufficient	Two individual assessments by psychiatrists; the closest relative brings the report to judges authorized to police escort Public Prosecutor	Two qualified psychiatrists in 24 h then Public Prosecutor orders the patient’s admission	–	Yes
Belgium	Loi modifiant la loi du 26 june 1990 relayive à la protection de la personne des malades mentaux 2017	Mental disorder	Danger for the health and safety of the person and others	Any interested person	Justice of the Peace	Observation period of maximum 40 days; the duration of maintenance cannot exceed 2 years (renewable)	Yes; Justice of the peace
The Netherlands	Rules may provide for compulsory care to a person with a mental disorder (Obligatory mental health) 2009; Compulsory admission Act 1992	Severe mental disorders that constitute a danger to themselves or others, including severe negligence or severe social inadequacy	Imminent danger for oneself and others	Doctor; judge	Judge	3 weeks (emergency procedure) 6 months (regular procedure)	Yes
France	Law n ° 2013–869 (27–9–2013)	Admission at a request of a third party: mental disorder	The mental disorder makes consent impossible and requires immediate care and medical supervision	Family member, guardian, or curator of the patient	The director of the establishment on the basis of two medical certificates	After the first period of observation (72 h) a month, renewable	Yes; college of experts, departmental commission
		Admission on the decision of the representative of the state: mental disorder	People whose mental disorder require care and jeopardize the safety of people or public order	Warden Home representative	Representative of the State
Germany	Different regulations and procedures for involuntary placements or treatments among Germany’s 16 federal states	Some federal states specify “psychosis”	Mental disorder and severe conditions “equivalent to psychosis” + danger (dangerous or self–destructive behavior)	“Physician” in some Federal States; “psychiatrist” or “physician experienced in psychiatry” in others	A specialist must be involved in assessment of psychiatric condition Maximum period of time between psychiatric assessment and compulsory admission different for each Federal State: ranging from 24 h to 14 days	Preliminary detention: 6 weeks regular placement 1 year, in obvious cases 2 years Reapproval of decision is 6 months (defined by Federal State of Saarland only)	Patients have the right to appeal to courts at any stage of the procedure Patients’ advocates are approved during all stages
Switzerland	Swiss civil code (Part three; third section; third paragraph: Forced hospitalization. Reviewed 2013)	Mental disorders or mental disability	The required treatment cannot be provided otherwise; to protect family members and third parties	–	Adult protection authority and doctors designated by the cantons	The period may not exceed 6 weeks	Yes; adult protection authority
Sweden	Compulsory Psychiatric Treatment Act 1991 Revised in 2000	Severe mental disorder	Need for care, unwilling/unable to decide, risk of harm to self/others due to m. disorder	Doctor in public service or Chief physician	Chief physician in 24 h	4 weeks	Yes; appeals of doctor’s decision of involuntary care are made to Administrative Court
Finland	Mental health act 1990	Mental disease	Need for treatment or serious danger to one’s health	Doctor employed in public health service or licensed physician or chief municipal medical officer	Within 3 days by a psychiatrist or trainee examines or three independent doctors	4 days of observation	By patient, next of kin, supervisor of commission
Norway	Amendment to the Mental Health Act; LOV–2012–06–22–48 Mental Health Care Act 1999 2007	Serious mental disorder	The prospects of their health being restored or significantly improved considerably reduced; it is highly probable that the condition of the person concerned will significantly deteriorate in the very near future; constituting an obvious and serious risk to their own life and health or those of others	Responsible mental health professional	Two physicians, one of whom shall be independent of the responsible institution	10 days	Yes; by the patient and their next of kin
Denmark	LBK nr 1729 af 02/12/2010 (Act on the use of coercion in psychiatry)	Someone who is supposed to be insane	The prospect of healing or a significant and decisive improvement in the condition will otherwise be significantly impaired or the patient presents an imminent and significant danger to themselves or others	Physician; the statement must not be issued by a doctor who is employed at the psychiatric hospital or the psychiatric ward where the hospitalization takes place	Chief physician in 48 h	–	Yes
Romania	Mental Health Law and protection of persons with mental disorders. Law 487/2002	Person with severe mental disorders: a person with mental disorders who is unable to understand the meaning and consequences of their behavior, so that they need immediate psychiatric help	The patient’s behavior presents an imminent danger of harm to themselves or to others; the patient does not have the psychic ability to understand the condition of the illness and the necessity of setting up medical treatment and has no legal representative or is not accompanied by a conventional representative	The family doctor or the psychiatrist specialist who takes care of this person; the family of the patient; representatives of the local public administration with attributions in the social–medical and public order domain; the gendarmerie or firemen, as well as the prosecutor; the civil court	Psychiatrist informs legal representative special committee: two psychiatrists and one specialist or a representative of civil society	Within 24 h of the psychiatric evaluation, the proposal for involuntary admission shall be examined by a special committee established within 48 h	Yes
Russia	Law on Mental Healthcare and Guarantees of the Citizens’ Rights in the Course of Care Provision 1993	Mental illness	Patients have to exhibit dangerous behavior toward themselves or others, they must be helpless and unable to provide for their basic daily needs, and there is a danger of “essential harm” to their mental health if they do not receive mental care	One psychiatrist	A commission of psychiatrists	48 h for assessment; documentation is sent to the local court, which has 5 days to review it; need for admission reevaluated every month for 6 months; then every 6 months; then every year	Yes; within 10 days from admission