SECOND SECTION
CASE OF H.H. v. FINLAND
(Application no. 19035/21)
 
 
JUDGMENT
 
Art 5 § 4 • Review of lawfulness of detention • Failure to grant the applicant an oral hearing in proceedings concerning her committal for involuntary treatment in a psychiatric hospital, and the administration of medication against her will • Effectiveness of the judicial review required undermined
 
Prepared by the Registry. Does not bind the Court. STRASBOURG
9 December 2025
 
FINAL
 
09/03/2026
 
 
This judgment has become final under Article 44 § 2 of the Convention. It may be subject to editorial revision. In the case of H.H. v. Finland,
The European Court of Human Rights (Second Section), sitting as a Chamber composed of:
 Arnfinn Bårdsen, President,
 Saadet Yüksel,
 Jovan Ilievski,
 Oddný Mjöll Arnardóttir,
 Gediminas Sagatys,
 Stéphane Pisani,
 Juha Lavapuro, judges,
and Hasan Bakırcı, Section Registrar,
Having regard to:
the application (no. 19035/21) against the Republic of Finland lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Finnish national, Ms H.H. (“the applicant”), on 8 April 2021;
the decision to give notice to the Finnish Government (“the Government”) of the complaints under Article 6 § 1, Article 8, Article 13 and Article 5 § 4 of the Convention;
the decision not to have the applicant’s name disclosed;
the observations submitted by the respondent Government and the observations in reply submitted by the applicant;
the comments submitted by the Validity Foundation, a non-governmental organisation with its registered office in Budapest, which was granted leave to intervene by the President of the Section;
Having deliberated in private on 18 November 2025,
Delivers the following judgment, which was adopted on that date:
INTRODUCTION
1. The application concerns the lack of an oral hearing in proceedings concerning the applicant’s committal for involuntary treatment in a psychiatric hospital, and the administration of medication against her will. THE FACTS
2. The applicant was born in 1968 and lives in Turku. She was represented by Mr M. Hakanen, a lawyer practising in Turku. 3. The Government were represented by their Agent, Ms K. Oinonen, of the Ministry of Foreign Affairs. 4. The facts of the case may be summarised as follows. PROCEEDINGS IN THE ADMINISTRATIVE COURTS
5. In April 2020, prior to the proceedings at issue in the present case, the applicant had visited a psychiatric unit more than 20 times. She was treated in a psychiatric hospital against her will under sections 8 and 11 of the Mental Health Act (mielenterveyslaki, mentalvårdslagen) from 31 March to 3 April 2020. Moreover, under sections 9 and 9(c) of the Mental Health Act, she was kept under observation from 3 April until 6 April 2020. Following an observation interview conducted on 6 April 2020, the applicant was discharged. She was admitted for observation a second time on 26 April 2020, which ended with her release on 29 April 2020. 6. On the basis of decisions issued by the chief medical officer on 9 April and 5 May 2020, the applicant was committed to hospital with a view to undergoing involuntary psychiatric treatment between 9 and 15 April 2020 and between 5 May and 31 July 2020, respectively. Consequently, the applicant was deprived of her liberty during those periods. 7. By another decision, on 31 July 2020, the applicant’s involuntary psychiatric treatment was extended, ultimately lasting until 26 April 2021. However, the applicant remained in treatment voluntarily until 25 May 2021. The decision of 31 July 2020 was submitted to the Turku Administrative Court for its approval. 8. The applicant submitted that between 2017 and 2020, including during the periods of her involuntary psychiatric treatment, she had on 29 occasions been administered medication without her consent. At the time, decisions taken by a doctor under the Mental Health Act concerning the medication of a patient were not subject to appeal (see X v. Finland, no. 34806/04, §§ 219‑20, ECHR 2012, and E.S. v. Finland [Committee], no. 23903/20, § 4, 18 June 2024). The Mental Health Act has since been amended to allow appeals against such decisions. Those amendments entered into force on 1 April 2024. 9. The applicant appealed against all three committal decisions to the Turku Administrative Court (hallinto-oikeus, förvaltningsdomstolen), each time requesting that the administration of medication against her will be discontinued and that an oral hearing be held so that the court could hear her in person. In her third appeal, she also proposed that three witnesses (two doctors and a nurse) be heard. She argued, inter alia, that any mental illness from which she was suffering did not require treatment in a hospital and that she was determined and motivated to receive psychiatric treatment by means of outpatient care. 10. By decisions of 3 and 26 June and 2 October 2020, the Administrative Court dismissed the applicant’s appeals against her committal for involuntary treatment. The court also refused to examine her requests for the discontinuation of the administration of medication against her will and for an oral hearing to be held. The court held that, as a rule, proceedings before administrative courts took place in writing. An administrative court would organise an oral hearing if it deemed it necessary or if a private party requested it. However, the court could refuse to hold an oral hearing despite a party’s request if adequate evidence of the facts that were of significance for deciding the case had already been obtained, on the basis of which the case could be decided without leaving the court in any reasonable doubt as to the facts. 11. The Administrative Court further found that an oral hearing was unnecessary in the present case because all the relevant facts could be established from the documents in the case file. Those included, inter alia, the complete case files compiled by the decision-making authorities, and statements by the chief medical officer and the ward physician, which had been given separately in each set of proceedings. Concerning the involuntary psychiatric treatment between 9 and 15 April 2020, the treatment period under appeal had ended (according to the applicant), so an oral hearing was not necessary. As to the involuntary psychiatric treatment between 5 May and 31 July 2020 and the decision to extend it beyond that period, the court noted that it had already held an oral hearing on 10 September 2018 in the proceedings following the applicant’s appeal against one of the previous committal decisions and that it was therefore unnecessary to hold another oral hearing in the case. 12. On 27 October 2020 the Supreme Administrative Court (korkein hallinto‑oikeus, högsta förvaltningsdomstolen) refused to grant the applicant leave to appeal against the Administrative Court’s decisions of 3 June and 26 June 2020. On 21 December 2020 the court refused to grant such leave against the decision of 2 October 2020. CIVIL PROCEEDINGS
13. On 24 July 2020 the applicant brought a civil action for compensation against the Government of Finland in the Varsinais‑Suomi District Court (käräjäoikeus, tingsrätten), contending that the administration of medication against her will and the lack of any judicial review had been in breach of her human rights. 14. By a judgment of 16 February 2024, the District Court ruled for the applicant. After examining the case under Articles 8 and 13 of the Convention and referring, in particular, to the Court’s judgment in X v. Finland (cited above, §§ 212-23) and the Supreme Court’s precedent case KKO 2023:93 of 29 November 2023 (see E.S. v. Finland, cited above, §§ 9-12), the District Court held that the applicant’s human rights under Article 8 of the Convention had been violated, as she had not been given the opportunity to appeal to a court against the decisions on the involuntary administration of medication (see paragraph 8 above). The District Court accordingly awarded her 5,000 euros in compensation, together with the accrued default interest. 15. The applicant did not appeal against the District Court’s judgment, which became final. RELEVANT LEGAL FRAMEWORK
I. DOMESTIC LEGISLATION
16. Section 8 of the Mental Health Act (mielenterveyslaki, mentalvårdslagen; Act no. 1116/1990) provides:
“A person can be ordered to undergo treatment in a psychiatric hospital against his or her will only:
1) if the person is diagnosed as mentally ill;
2) if the person needs treatment for a mental illness which, if not treated, would become considerably worse or severely endanger the person’s health or safety or the health or safety of others; and
3) if all other mental health services are inapplicable or inadequate.”
17. Section 12, subsection 1, of the Mental Health Act (as amended by Act no. 438/2014) provides:
“A person ordered to undergo treatment may, on the basis of a decision referred to in section 11, be detained for treatment against his or her will for a maximum of three months. If it seems probable before the end of this period that the treatment will have to be extended beyond that date, but the patient does not agree with this, a new observation report shall be produced indicating whether or not the conditions for ordering the patient to undergo treatment against his or her will are still met. A decision on whether the treatment should be continued or discontinued shall be made in writing by the physician referred to in section 11 before the treatment has lasted for three months. A decision to continue treatment shall be made known to the patient without delay and submitted immediately for approval by an administrative court.”
18. Section 57 of the Administrative Judicial Procedure Act (laki oikeudenkäynnistä hallintoasioissa, lagen om rättegång i förvaltningsärenden; Act no. 808/2019) provides:
“An administrative court shall arrange an oral hearing if the court deems this necessary or if a private party so requests. At the oral hearing a party, the authority that issued the decision, witnesses and experts may be heard, and other evidence may also be accepted. The court may decline to arrange an oral hearing despite the request of a party if:
1) the status of the party requesting an oral hearing is based on membership of a municipality or other entity;
2) adequate evidence of the facts that are of significance for deciding the case has already been obtained, on the basis of which the case may be decided without leaving the court in any reasonable doubt as to the facts;
3) the facts may be established in some other way;
4) an oral hearing has already been arranged in the same case in an administrative court; or
5) it is otherwise manifestly unnecessary to arrange an oral hearing, having regard to the nature and significance of the case for the party and the requirements of a fair trial. The Supreme Administrative Court may also decline to organise an oral hearing despite the request of a party if the case concerns a request for a review of a decision of an administrative court and it is not necessary to organise an oral hearing in order to examine the case. A person requesting an oral hearing shall state why it is necessary to organise one, and what evidence he or she would present at the oral hearing. If the statement of an expert or private written testimony is relied on in a case, then an oral hearing shall only be organised to hear the expert or witness if this is necessary for examining the case.”
II. preparatory work and domestic case-law
19. The preparatory work on section 57, subsection 2 (points 4 and 5) and subsection 5 of the Administrative Judicial Procedure Act (Government Bill to Parliament HE 29/2018 vp) states that, in mental health cases concerning involuntary treatment, it is appropriate to organise oral hearings at regular intervals as such cases involve interference with a party’s personal liberty. However, the obligation to hold an oral hearing for the purposes of hearing a witness or an expert is limited to situations where such a hearing is necessary in order to clarify the matter. An oral hearing is usually not necessary when no grounds have been found for doubting the plausibility of witness testimony or an expert statement. However, the necessity assessment is also influenced by any request from other parties to the proceedings to hear orally a witness who testified in writing or to put questions to an expert (see, for example, Letinčić v. Croatia, no. 7183/11, 3 May 2016). An expert should be heard in court when, for instance, this is necessary to eliminate any vagueness or deficiency in his or her previous statement. Moreover, an expert should be heard orally if a party so requests and the hearing would not be manifestly unnecessary. In those cases, the court also assesses the need for the hearing. 20. The Supreme Administrative Court has stated in its precedent case KHO 2009:2339 that the right to a fair trial guaranteed by section 21 of the Constitution, as interpreted in the light of Article 5 § 4 of the Convention, requires that, if involuntary psychiatric hospital treatment lasts for a long time, the Administrative Court must conduct an oral hearing at reasonable intervals if the individual concerned so requests. 21. Moreover, in its precedent case KHO 2021:22, the Supreme Administrative Court held that the exceptions under section 57 of the Administrative Judicial Procedure Act concerning the holding of an oral hearing must be interpreted in the light of the main rule in section 57, subsection 1, of the Act and the case‑law of the Court. In addition to the point of view of a court, the importance of an oral hearing lies in the ability of the parties to put questions directly to the opposing party and to summon witnesses. THE LAW
ALLEGED VIOLATION OF THE RIGHT TO AN ORAL HEARING
22. The applicant complained, under Article 6 § 1 of the Convention, that she had not had an oral hearing before the Administrative Court in the proceedings concerning her involuntary treatment. She also complained about that court’s refusal to hear witnesses she had proposed. 23. The Court notes that complaints about proceedings in respect of involuntary confinement for treatment concern deprivation of liberty and fall to be examined under Article 5 § 4 of the Convention, which is the lex specialis in relation to Article 6 (see Reinprecht v. Austria, no. 67175/01, §§ 47-55, ECHR 2005-XII, and Raudevs v. Latvia, no. 24086/03, § 107, 17 December 2013). Furthermore, the Court considers that the applicant’s complaint about the Administrative Court’s refusal to hear witnesses is absorbed by her complaint concerning the lack of an oral hearing. 24. Article 5 § 4 of the Convention reads as follows:
“Everyone who is deprived of his liberty by arrest or detention shall be entitled to take proceedings by which the lawfulness of his detention shall be decided speedily by a court and his release ordered if the detention is not lawful.”
Admissibility
25. The Court notes that this complaint is neither manifestly ill‑founded nor inadmissible on any other grounds listed in Article 35 of the Convention. It must therefore be declared admissible. MeritsThe parties’ submissions

26. The applicant pointed out that she had not had an oral hearing before the Administrative Court and that she had not been able to have witnesses heard. 27. The Government noted that, in all three sets of proceedings in question, the applicant had had an opportunity to state her position in writing and had submitted several pleadings and rejoinders to the Administrative Court. The Administrative Court had heard the applicant in writing several times concerning the relevant facts. In addition, the Administrative Court had had access to numerous pieces of written evidence, such as medical records and medical certificates concerning the applicant. In accordance with section 57, subsection 2 (point 4) of the Administrative Judicial Procedure Act, a court could refuse to organise an oral hearing despite a request from a party if an oral hearing had already been organised in the same case in an administrative court. Taking into account the comprehensive written evidence presented in all three sets of proceedings and the oral hearing held in 2018, it had been justifiable for the Administrative Court to consider it unnecessary to hold an oral hearing. Thus, in the Government’s view, the requirements of fairness had been complied with and the particular circumstances of the present case had not necessitated the holding of an oral hearing. 28. The Validity Foundation noted in its third-party submissions that the right to be present and heard – which was one of the fundamental guarantees of a fair trial – was closely connected to the principle of equality of arms and ensured the adversarial nature of the proceedings. The right to a fair trial, or related procedural obligations under Article 8 of the Convention, implied the right of persons with disabilities to participate in the proceedings, to be heard in person, and to benefit from accommodations in order to be able to effectively engage with the proceedings. All procedural accommodations had to have the aim of facilitating, rather than replacing, individuals’ genuine participation and ability to express themselves in the proceedings.

Outcome for Article 5: violation