Psychiatry: Compulsory Treatment Orders – between care and constitutional safeguards
We must ensure that a measure of a public health nature is not gradually reduced to a predominantly judicial framework
The recent judgement no. 157/2026 of the Constitutional Court of 2 October, which introduced the requirement for legal representation in proceedings to validate and extend Compulsory Health Treatment (Tso), raises important issues to which we believe it is necessary to draw the attention of the institutions.
We fully recognise the value of the constitutional guarantees protecting personal liberty and the right to a fair trial, as reaffirmed by the Court. We nevertheless consider it essential that their application takes account of the specific nature of compulsory treatment orders (TSO), ensuring that a measure of a healthcare nature is not gradually reduced to a predominantly judicial framework.
What is TSO?
Law No. 180 of 1978, the principles of which were subsequently incorporated into Law No. 833 of the same year, placed compulsory treatment (TSO) within the framework of health protection, moving beyond a conception of psychiatry based primarily on detention. Compulsory Treatment Order (CTO) constitutes an exceptional therapeutic intervention, envisaged when mental disorders exist that require urgent therapeutic intervention, the person refuses such intervention, and the conditions are not in place to adopt timely and appropriate non-hospital-based healthcare measures.
Its purpose is not to restrict personal freedom as such, but to safeguard the right to health even when it is not possible to obtain consent for the necessary treatment. The doctor who proposes or confirms, on medical grounds, the need for compulsory treatment does not act as the patient’s counterpart, but in the exercise of clinical responsibility.
The introduction of mandatory legal representation, whilst strengthening individual safeguards, requires particular attention to be paid to the practical arrangements under which it will be integrated into the validation procedure. There is a risk that the discussion will gradually take on the characteristics of adversarial proceedings, in which the doctor is called upon to defend their actions as a party to the proceedings and the patient is portrayed as standing in opposition to the treating staff.
