REPUBLIC OF LITHUANIA

REPUBLIC OF LITHUANIA Official translation REPUBLIC OF LITHUANIA LAW ON MENTAL HEALTH CARE 6 June 1995 No I-924 Vilnius (As amended on 5 July 2005 No X-309) Chapter I GENERAL PROVISIONS Article

1. Main Definitions of the Law
2. Mental illness means a disease diagnosed by a medical doctor and certified by a psychiatrist which, pursuant to the effective classification of diseases, is assigned to mental diseases. A mental disease may not be diagnosed on political, religious, racial grounds;
3. Patient means a mental patient or any other person to whom mental health care is applied;
4. Mentally ill person means a person ill with a mental disease;
5. Patient’s representative (representative) means a statutory representative in pursuance of Article 6.744 of the Civil Code or a representative by power of attorney. A representative by power of attorney shall be chosen by the patient. The authority of a representative by power of attorney must be executed in accordance with the procedure laid down by the Civil Code;
6. Mental health facility means a health care institution (public or non-public), which is accredited for mental health care. If only a certain part (unit) of a medical aid institution has been accredited to engage in mental health care, the term shall apply only to the unit. In this Law the term is also applicable to psychoneurological facilities;
7. Medical ethics commission means a commission formed in a mental health facility for addressing the issues of medical ethics;
8. Mental health centre means a municipality-owned institution accredited by the government to engage in mental health care and to provide social assistance to the mentally ill and other persons;
9. Psychiatrist means a medical doctor entitled under the statutes of the Republic of Lithuania to practice psychiatry;
10. Psychotherapist means a person entitled under the statutes of the Republic of Lithuania to practice psychotherapy. In the event that the psychotherapist provides the mentally ill person with psychiatric aid, the requirements of this Law shall be applicable to him;
11. Psychologist means a person entitled under the statutes of the Republic of Lithuania to provide the mentally ill with psychological aid. If the psychologist provides the mentally ill with psychological aid, the requirements of Chapter Four of this Law shall apply to him;
12. Nursing staff means medical aid institution personnel nursing the mentally ill;
13. Mental health care means specialised health care carried out in accordance with the standards approved by the Ministry of Health of the Republic of Lithuania. Its purpose is provision of psychiatric aid (diagnosis, treatment of mental functions disorders, timely prevention of exacerbation of mental diseases), helping a person to rehabilitate and return to life in the community;
14. Hospitalisation means a person’s admission to a psychiatric institution as a patient;
15. Mental health means a natural state of individual’s selfhood which must be preserved or restored in the cases of disorders and illnesses. According to the definition set out by the World Health Organisation – mental health is emotional and psychological strength which allows to experience joy and cope with pain, disappointment, sorrow. This is a positive feeling of good, upon which the faith in dignity and value of oneself and other people rests. Article
16. The purpose of the Law on Mental Health Care of the Republic of Lithuania is to establish the rights of the persons who are provided with mental health care, the procedure and supervision of mental health care. Chapter II RIGHTS OF MENTALLY ILL PERSONS AND RESTRICTIONS THEREOF Article
17. Mentally ill persons shall have all political, economic, social and cultural rights. There shall be no discrimination on the grounds of mental illness. A person with a background of mental disease may not be discriminated against by reason thereof. A person who discriminates against a mentally ill person by reason of the latter’s present or past mental health disorders shall be held liable in accordance with the procedure established by the laws of the Republic of Lithuania. Article
18. A mentally ill person who is not able to understand the meaning of his actions or control them may in judicial proceedings be declared incapable. The incapable mentally ill person shall be placed under guardianship in accordance with the procedure established by the Civil Code. Article
19. The state must provide mentally ill persons with conditions for development, help them acquire work skills, change their qualifications, rehabilitate and return to life in the community. The procedure of establishment and operation of institutions for the development of and care for the mentally ill shall be regulated by the laws and other legal statutes of the Republic of Lithuania. The terms and conditions of establishment and operation of special schools, kindergartens, special groups (classes) in educational institutions shall be laid down by the Ministry of Education and Science and by the municipalities. Minors may also be enrolled in the general type groups and classes. Article
20. Mentally disabled persons shall be taken care of by the state. They shall be provided with social assistance in compliance with the procedure laid down by the laws of the Republic of Lithuania. Health care of mentally disabled persons shall be financed in the manner established by the laws of the Republic of Lithuania. The municipality shall organise and support the nursing and care of the mentally disabled in their families, health care institutions, mental health centres and other institutions of care and rehabilitation. Chapter III THE RIGHTS OF HOSPITALISED PATIENTS AND RESTRICTIONS THEREOF Article
21. Hospitalised patients shall have the right to: 1) communicate with other persons (including other patients), have freedom of access to telephone, telegraph, postal services and other means of communications; 2) receive, in private, regular visits from their representatives, other visitors; 3) send and receive all kinds of private or public statements, letters which may not be read or censored by other persons; 4) purchase and receive the necessary items; 5) be provided with a possibility to enjoy privacy; 6) perform religious rites; 7) read, go in for sports, and enjoy other types of leisure activities; 8) receive audio-visual information; 9) study and expand their knowledge; 10) engage in the activities suited to their social and cultural background and aimed at promoting rehabilitation and reintegration in the community. Conditions for fulfilling the above-mentioned requirements shall be provided for in the internal regulations of a mental health facility. The patients’ rights defined in this Article may be restricted on the psychiatrist’s decision only in the event of a real threat to the patient himself or to others. The restrictions must be recorded in the patient’s clinical record. The above-stated rights of patients may be restricted in accordance with the procedure specified by the laws of the Republic of Lithuania. Article
22. In a mental health facility the patient shall realise his rights himself or through his representative. The administration of a mental health facility must assist the patient in reaching his relatives, representative. Article
23. The labour activity of mentally ill persons hospitalised in a mental health facility must be voluntary, having a therapeutic and rehabilitative effect and helping them to return to the community. The requirements of conditions of work and length of work period of the mentally ill persons shall be determined by the Ministry of Health. Labour activity must recommended and controlled by the psychiatrist. It shall be prohibited to force a mentally ill person to work. Production-rehabilitation sections of mental health facilities must be structural subdivisions of said institutions. The procedure of their organisation and operation shall be determined by the Ministry of Health. Chapter IV THE PATIENTS’ MENTAL HEALTH CARE Article
24. Patients shall have the right to receive appropriate, accessible and suitable health care. A patient shall have the right to choose a psychiatrist, a mental health facility and type and scope of health care or to refuse same. The right may be restricted if circumstances specified in Article 27 of this Law exist as well as in the event of mental health care being provided in the cases provided for in Chapters 8 and 9 of this Law. Article
25. Mental health care (out-patient or in-patient) shall be provided according to the person’s place of residence at the mental health centres, as well as at other mental health facilities, care and custody institutions. The mental health centre shall be established by the municipality. Its activities shall be governed by the regulations approved by the Government of the Republic of Lithuania. Article
26. The conditions of the patients’ mental health care at the time of their hospitalisation may not be inferior to the treatment and nursing conditions of persons ill with other diseases. Article
27. The patients’ health care conditions shall be determined by the psychiatrist, seeking to ensure that the treatment and nursing conditions offer the least restrictive environment. The actions of a mentally ill person may be subject to restrictions only provided that the circumstances specified in Article 27 of this Law are manifest. A recording to the effect must be promptly made in the clinical record. Article
28. Patients shall have the right to confidentiality with regard to information concerning their health. The psychiatrist, other medical doctor, nurse and other staff members, the administration of a health care facility must guarantee the above-stated right of the patient in compliance with the laws of the Republic of Lithuania and according to the requirements of medical ethics. Information concerning the patients’ state of health shall be furnished to other persons in compliance with the procedure established by the laws of the Republic of Lithuania. Article
29. The psychiatrist must inform the patient, in a form comprehensible to the latter and with an explanation of the special medical terms involved, of the condition of his health, disease diagnosis, possible treatment methods, prognosis of the treatment and other circumstances which may have an effect upon the patient’s decision to consent or refuse the proposed treatment, as well as of the effects, in case the patient refused the proposed treatment. The patient shall have the right of access to his medical record, extracts from his medical record. Such information may not be provided to the patient, if it may cause harm to his health or even endanger his life. A decision regarding the restrictions on the communication to the patient of the information referred to in paragraph 1 of this Article or the access of the patient to his medical record, extracts from his medical record shall be taken by the psychiatrist who shall make an appropriate recording in the patient’s medical record. In the cases where the patient’s right to be provided with the information referred to in paragraph 1 of this Article, to get access to his medical record, extracts from his medical record is restricted, as well as in the cases provided for in Article 6.728 of the Civil Code, the appropriate information shall be communicated to a representative of the patient. The said information shall be communicated to the patient as soon as the risk of causing the said harm to the patient by the notification of such information is eliminated. Extracts from the medical record shall be arranged in such a manner as not to harm the interests of third persons. At the request of the patient or his representative, extracts from the medical document shall be furnished to him within 3 working days. The patient’s representative shall also have the right of access to other medical documentation directly concerning the interests of the represented person. The attending psychiatrist or the mental health facility administration must promptly furnish the representative with such information and documents. If the patient is a minor, the information must be presented to his parents or guardians (curators). Article
30. No treatment shall be given to a patient without his consent, except when he is involuntarily hospitalised by reason of circumstances specified in Article 27 of this Law. In such case the psychiatrist shall inform the patient and (or) his representative of the prescribed involuntary treatment. The information must be entered in the patient’s medical record. In the cases specified in paragraph 1 of this Article the authorisation for the patient’s involuntary treatment must be obtained in accordance with the procedure laid down in Article 28 of this Law. Until the authorisation of the court is granted, the patient may, upon the decision of two psychiatrists and one doctor-representative of the mental health facility administration, be subjected to involuntary treatment for not longer than 48 hours. The patient may be subjected to involuntary treatment only if he has been hospitalized in a compulsory manner in an inpatient mental health facility. Article
31. If a minor has not been emancipated by the court, he may be given treatment with the written consent of at least one of the parents or the guardian (curator). If one of the parents or the guardian (curator) refuses treatment prescribed by the psychiatrist and this is likely to result in irreparable damage being inflicted on the minor’s health, the psychiatrist must immediately apply to the court and obtain its authorisation for giving the minor treatment without the consent of one of the parents or the guardian (curator). Minors shall be hospitalised and given treatment separately from adult patients. Article
32. Mentally ill persons may be prescribed only the methods of treatment approved in accordance with the procedure laid down in the legal statutes of the Republic of Lithuania. Methods of treatment which have irreversible harmful effect on health may not be applied to incompetent mentally ill persons. Clinical experimental methods of treatment, psychosurgery may be applied with respect to mentally ill persons only for the purpose of treatment under the supervision of the medical ethics commission. Clinical experimental methods of treatment, psychosurgery may be applied only with the written informed consent of the mentally ill person certified by two witnesses and the head physician of the mental health facility. Approval of the medical ethics commission must also be received. Article
33. In emergency cases, seeking to save a person’s life when the person himself is unable to express his will and his life is seriously endangered, necessary medical care may be taken without the patient’s consent. Where instead of the patient’s consent, the consent of his representative is required, the necessary medical care may be provided without the consent of such person provided if there is insufficient time to receive it in cases where immediate action is needed to save the life of the patient. In those cases when urgent actions must be taken in order to save the patient’s life, and the consent of the patient’s representative must be obtain in lieu of the patient’s consent, immediate medical aid may be provided without the said consent, if there is no enough time to obtain it. Chapter V THE RIGHT OF THE PATIENT OR HIS REPRESENTATIVE TO APPEAL AGAINST HEALTH CARE CONDITIONS Article
34. The patient or his representative shall have the right to appeal to the administration of a mental health facility, the Ministry of Health Care or the court against the conditions of health care. Article
35. The patient or his representative shall have the right to present to the administration of a mental health facility, the Ministry of Health Care or the court medical findings regarding the health condition, health care conditions as well as other documents issued by a chosen psychiatrist. Article
36. The patient or his representative shall have the right to be present and be heard out at the administration of a mental health facility, the Ministry of Health Care or the court when the issues concerning his involuntary hospitalisation and treatment, treatment, etc. are being decided. Chapter VI HOSPITALISATION OF PATIENTS Article
37. The primary examination and assessment of the patient’s mental condition may be performed by the psychiatrist on reasonable suspicion of a severe mental illness the symptoms whereof are identified in Article 27 of this Law. Primary examination of the person’s mental condition shall be conducted in accordance with the procedure established by the Ministry of Health. A medical doctor, the patient’s representative, his close relatives, the police may request his primary examination. Article
38. If a patient applies with a request to be hospitalised, he may be hospitalised only provided that: 1) at least one psychiatrist, upon examining the patient, recommends he should be treated as an inpatient at a mental health facility; 2) he has been informed about his rights at a mental health facility, the purpose of hospitalisation, the right to leave the psychiatric facility and restrictions of the right as specified in Article 27 of this Law. Article
39. Patients who are minors may be hospitalised only with the consent of one of the parents or his guardian except for the circumstances specified in Article 27 of this Law. In case of involuntary hospitalisation of a minor by reason of circumstances specified in Article 27 of this Law, involuntary hospitalisation and involuntary treatment conditions prescribed by this Law shall be applicable to him. If the patient who is a minor is under the age of 10 years, one of the parents or guardians shall have the right to be admitted to hospital with him. In the event of hospitalisation of a patient who is a minor and over the age of 10 years, one of the parents or the guardian (curator) may ask a psychiatrist to be allowed to stay at the mental health facility together with the minor. Decision on the issue shall rest with the psychiatrist who shall take into account the character of the illness and the minor’s mental condition. If the parents or guardians (curators) object to the psychiatrist’s decision, they may appeal against it to the administration of a mental health facility, the Ministry of Health Care or the court. Article
40. Patients hospitalised in compliance with the requirements of Article 24 of this Law shall have the right to leave the mental health facility at any time, provided that there are no circumstances specified in Article 27 of this Law. Article
41. A person who is ill with a severe mental illness and refuses hospitalisation may be admitted involuntarily to the custody of the hospital only if there is real danger that by his actions he is likely to commit serious harm to: 1) his health, life; 2) to the health, life of others. Article
42. When the circumstances specified in Article 27 of this Law do exist, the patient may be involuntarily hospitalised and administered treatment in a mental health facility for a period not exceeding 48 hours without the authorisation of the court. If the court does not grant the authorisation within 48 hours, involuntary hospitalisation and involuntary treatment must be terminated. The administration of a mental health facility must forthwith notify the patient’s representative about the involuntary hospitalisation. When a patient is hospitalised in a compulsory manner, the administration of a mental health facility must appeal to the court not later than within 48 hours. Having considered the recommendations of the psychiatrists, the court shall have the right make a decision regarding the extension of the patient’s involuntary hospitalisation and involuntary treatment period, but for no longer than one month from the beginning of the involuntary hospitalisation. Following the psychiatrist’s recommendations the administration of a mental health facility shall have the right to terminate the patient’s involuntary hospitalisation and involuntary treatment prior to the expiry of the term. Should it be necessary to prolong involuntary hospitalisation and involuntary treatment of the patient, the administration of a mental health facility must apply to the court regarding the said extension. The court may, based on the conclusions of the mental health facility, either prolong or terminate the patient’s involuntary hospitalisation and involuntary treatment, but each time for a period not exceeding 6 months. On the recommendation of the attending psychiatrist, the administration of a mental health facility shall have the right to terminate the patient’s involuntary hospitalisation and involuntary treatment prior to the expiry of the prescribed time period. When solving issues regarding involuntary hospitalisation and involuntary treatment of mental patients, the administration of a mental health facility must apply for provision of secondary legal aid, if such person is not represented by his representative. Article
43. Where the circumstances specified in Article 27 exist, a patient shall, at the request of the patient’s representative, on doctor’s instructions or by the ruling of the judge, be taken for involuntary treatment by the police, with the participation of the doctor. Institutions authorised by the Government shall lay down the procedure of involuntary hospitalisation. Article
44. A mentally ill person who is being involuntarily admitted to a mental health facility as a patient must acknowledge by his signature that he has been informed by the mental health facility administration about his involuntary hospitalisation and his rights at the mental health facility. If the mentally ill person refuses or is unable to put his signature, the fact of his having been informed about his involuntary hospitalisation shall be testified in writing by two witnesses who may be mental health facility staff members but not psychiatrists. Article
45. A person’s hospitalisation in violation of the requirements of this Law shall be illegal. Persons through whose fault a person was illegally hospitalised shall be held liable in the manner established by the laws of the Republic of Lithuania. Chapter VII PROCEDURE FOR CONDUCTING FORENSIC PSYCHIATRIC EXAMINATION Article
46. Grounds of forensic psychiatric examination and procedure for prescribing the examination shall be regulated by the Codes of Criminal Procedure and Civil Procedure of the Republic of Lithuania. Article
47. Inpatient forensic psychiatric examination shall be conducted only at mental health facilities. During the examination period mental health care shall be provided in compliance with the requirements of this Law. During the period of examination the patients shall have all the rights determined by this Law except for the right to choose a mental health facility, conditions of health care. The patients’ rights established in paragraphs 1, 2, and 3 of Article 7 of this Law may be restricted on the decision of the official who prescribed the inpatient forensic psychiatric examination. Chapter VIII MENTAL HEALTH CARE PROVIDED TO PERSONS SENTENCED TO A TERM OF IMPRISONMENT WHO BECOME MENTALLY ILL Article
48. Persons sentenced to a term of imprisonment who become mentally ill shall be provided with mental health care during their term in prison in compliance with the requirements of Chapter 4 of this Law at mental health facilities located in places of imprisonment. Article
49. The rights of mentally ill persons who undergo treatment in places of imprisonment may be subject to restrictions according to the requirements of this Law and other laws of the Republic of Lithuania like those of other persons sentenced to a term of imprisonment. Chapter IX MENTAL HEALTH CARE PROVIDED TO MENTALLY ILL PERSONS WHO HAVE COMMITTED AN ACT DANGEROUS TO THE PUBLIC (A CRIMINAL ACT) Article
50. The issue concerning involuntary hospitalisation and involuntary treatment of mentally ill persons who have committed an act dangerous to the public and have been recognised as being of diminished responsibility shall be decided by court in accordance with Article 27 of this Law and the Criminal Code of the Republic of Lithuania. Article
51. On the recommendation of a mental health facility and having decided, based on the findings of the mental health facility, that a person must undergo treatment after being involuntarily hospitalised, the court must indicate the mental health facility to which the person must be admitted involuntarily as a patient and determine the length of involuntary hospitalisation period as well as determining the conditions of health care. After the lapse of 6 months or earlier, if necessary, the court must consider, based on the findings of the mental health facility, and upon the recommendation of the mental health facility the issue of involuntary hospitalisation and involuntary treatment, and prolong hospitalisation and the above treatment, each time, however, for a period not exceeding 6 months, or must terminate same. Article
52. The requirements of this Law, except for the right to choose a mental health facility and health care conditions, shall apply to the mentally ill persons involuntarily hospitalised pursuant to a court order. Chapter IX1 STATE MENTAL HEALTH COMMISSION UNDER THE GOVERNMENT OF THE REPUBLIC OF LITHUANIA Article
53. The State Mental Health Commission under the Government of the Republic of Lithuania (hereinafter referred to as “the SMHC”) shall be established and its regulations shall be approved by the Government. The activities of the SMHC shall be regulated by the Law on Health System, this Law and the regulations of he SMHC, and shall be financed from the State budget. The SMHC shall consist of the representatives of the Ministry of Health Care, the Ministry of Social Security and Labour, the Ministry of Education and Science, the Ministry of the Interior, the Ministry of Justice, the representatives of public organisations proposed by the Association of Local Authorities in Lithuania, the Ministry of Health Care, as well as the representatives of large traditional religious communities; the composition of the SMHC and the procedure of establishment thereof shall be set out by the regulations of this Commission. The State Mental Health Commission under the Government of the Republic of Lithuania shall: 1) analyse the state of mental health of Lithuania’s population; 2) co-ordinate the practical implementation of mental health policy and strategy; 3) submit proposals to the Government and the Seimas with regard to drafts of laws and other legal acts, as well as proposals to the Government, the ministries, other State administrative institutions concerning practical resolution of problems related to mental health; 4) evaluate and present conclusions and proposals regarding drafts of national mental health programmes and other mental health-related programmes; 5) analyse the effect of public moral environment and promoted values on mental health of the population; 6) evaluate the relation between mental health of the population, tendencies of its changes and the development of the State, educational, social and economic changes carried out in the State; inform the Seimas, the Government and the public about that; 7) prepare annually and present to the Seimas and the Government a report on the state of mental health of the population and about the implementation of the related policy; 8) represent the Republic of Lithuania abroad within the limits of its competence; 9) perform other functions provided for in laws and the SMHC regulations. The SMHC shall have the right to: 1) receive drafts of laws and other legal acts, information necessary to carry out activities of the SMHC from the Government, the ministries, other governmental agencies, State administrative and municipal institutions, agencies, enterprises, organisations; 2) conduct within the limits of its competence the examination of legal acts and programmes on social and economic development, and submit its conclusions to the persons who drafted the said documents; 3) participate in the deliberation of issues concerning mental health policy and other issues having an effect on public mental health in the Government, meetings of the Seimas committees and commissions, the ministries, other governmental agencies, county administrations and local authorities; 4) disseminate information about its activities, promote its goals and objectives. Chapter X Repealed Chapter XI RESPONSIBILITY FOR VIOLATIONS OF THE LAW ON MENTAL HEALTH CARE Article
54. Persons who violate the requirements of this Law shall be held liable in accordance with the procedure established by the laws of the Republic of Lithuania. Article
55. A person who violates the requirements of Article 14 of this Law shall redress property and non-pecuniary damage incurred on the said patient in accordance with the procedure laid down by laws of the Republic of Lithuania. Chapter XII FINAL PROVISIONS Article
56. The Law on Mental Health Care shall come into effect as of 1 January
57. I promulgate this Law passed by the Seimas of the Republic of Lithuania. Algirdas Brazauskas President of the Republic