Mental health law in Europe: Structures, standards, and ethical dilemmas a comparative analysis of 38 national frameworks in light of international guidelines, regarding involuntary measures in mental healthcare services

• João Cortes Cardoso ^[1] ; Cíntia Águas Pereira ^[1] ; Silvana Galderisi ^[2] ; Mariana Pinto da Costa ^[3] ; Meryam Schouler-Ocak ^[4] ; Thomas Pollmächer ^[5] ; Luís Madeira ^[1]
  1. [1] Universidade de Lisboa

     Universidade de Lisboa

     Socorro, Portugal

     
  2. [2] Second University of Naples

     Second University of Naples

     Caserta, Italia

     
  3. [3] Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK South London and Maudsley NHS Foundation Trust, London, UK Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
  4. [4] Psychiatric University Clinic of Charité at St. Hedwig-Hospital Berlin, Germany
  5. [5] Center for Mental Health, Klinikum Ingolstadt, Ingolstadt, Germany Department of Psychiatry and Psychotherapy, LMU Munich, Munich, Germany

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• Localización: European journal of psychiatry, ISSN 0213-6163, Vol. 39, Nº 4, 2025
• Idioma: inglés
• DOI: 10.1016/j.ejpsy.2025.100326
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  • Abstract Background and Objectives In recent years, tensions have risen between the legislative context of Mental Health Laws (MHL) across Europe and the provisions set forth by the UN Convention on the Rights of Persons with Disabilities, pointing to ongoing discussions about autonomy and the conditions under which involuntary measures may occur.

    Methods A comparative analysis of national Mental Health Laws (MHL) across 44 European countries was conducted, focusing on legal frameworks for involuntary psychiatric care. It identifies 38 countries with MHL, excluding six without national legislation or where mental health is governed by regional frameworks. Data were collected from official sources and verified through the WHO Mental Health Atlas 2020. A total of 38 MHLs were analysed across four key domains: general definitions, formal procedures for involuntary admission, emergency procedures, and best practices in involuntary care.

    Results All MHLs require the presence of a mental disorder for involuntary admission, with 92 % also citing dangerousness. However, only 45 % provide a legal definition of mental disorder, and 29 % reference international diagnostic criteria (e.g., ICD, DSM). Procedures for involuntary admission are typically initiated by healthcare professionals (66 %), with courts serving as the primary deciding authority in 76 % of cases. Emergency detention durations vary, with many countries lacking clear limits. Best practices—such as distinguishing admission from treatment, allowing outpatient commitment, and requiring periodic legal review—are applied inconsistently. Only 14 countries explicitly prohibit controversial practices like psychosurgery or non-consensual ECT. While most laws emphasize protection of rights, the study highlights ethical tensions with the UN Convention on the Rights of Persons with Disabilities (CRPD), particularly around involuntary measures. Limitations include reliance on translated texts, the omission of subnational laws, and the lack of enforcement analysis.

    Conclusions These findings highlight the need for harmonized legal standards, enhanced procedural safeguards, and stronger rights-based frameworks in mental health legislation across Europe. Reforms should aim for standardized legal definitions, clearer procedures, and alignment with international norms, while remaining sensitive to clinical and cultural contexts.