Albertani v. Italy (Application No. 15994/20)

On 4 June 2026, the First Section of the European Court of Human Rights (ECtHR) delivered its judgment in Albertani v. Italy, criticising the Italian State for structural shortcomings within its prison system. The judgment identifies systemic deficiencies concerning mental healthcare in places of detention and, more specifically, highlights the inadequacies of the Italian legal framework following the closure of the Judicial Psychiatric Hospitals (Ospedali Psichiatrici Giudiziari – OPGs) and their replacement by the Residences for the Execution of Security Measures (Residenze per l'Esecuzione delle Misure di Sicurezza – REMSs).

The applicant, Stefania Albertani, is an Italian national who had been diagnosed with severe psychiatric disorders. Following the commission of several criminal offences, she had been placed in the Judicial Psychiatric Hospital of Castiglione delle Stiviere.

Following the enactment of Law No. 81/2014, which ordered the closure of all OPGs, REMSs were established as their institutional replacement. However, both the legislative framework and its subsequent implementation provided that REMSs were to be used exclusively for the enforcement of security measures and not for the placement of ordinary prisoners who subsequently developed a mental disorder while serving their sentence, as regulated by Article 148 of the Italian Criminal Code.

Due to the chronic shortage of places within REMSs, the legislative gaps created by the above-mentioned reform, and the complete absence of alternative therapeutic pathways, the applicant was required to serve a period of detention in an ordinary prison, namely the San Vittore Prison in Milan. It is important to note that this institution was, and continues to be, affected by chronic prison overcrowding exceeding 220% of its official capacity.

As a consequence, the applicant remained unlawfully detained despite the repeated recognition of her severe psychiatric needs. These circumstances gave rise to a violation of Article 3 of the European Convention on Human Rights, which prohibits torture and inhuman or degrading treatment or punishment. The applicant argued that her prolonged detention in an ordinary prison, under conditions of severe overcrowding and in the absence of continuous psychiatric and psychotherapeutic treatment tailored to her clinical condition, amounted to inhuman and degrading treatment.

A further violation concerned Article 5 of the Convention, which protects the right to liberty and security. As repeatedly confirmed by psychiatric expert reports, detention in an ordinary prison did not satisfy the legal requirements applicable to persons suffering from serious mental disorders. The Italian authorities failed to provide the applicant with the therapeutic placement required by her condition, thereby depriving her of her liberty without an appropriate legal basis and without any genuine therapeutic purpose.

The judgment also emphasised the absence within the Italian legal system of an effective, timely, and preventive judicial remedy enabling the applicant to challenge the lawfulness of her detention in light of the established incompatibility between her psychiatric condition and detention in an ordinary correctional facility. This constituted a further violation of Article 5.4 and Article 13 of the Convention, which guarantee the right to judicial review of detention and the right to an effective remedy.

The Italian Government argued that the difficulties encountered were attributable to the structural transition following the closure of the OPGs and the establishment of the REMSs. It further maintained that the prison administration had nevertheless attempted to activate the available mental health services and that the applicant had received some form of medical monitoring while detained. Finally, the Government raised a preliminary objection concerning the applicant's alleged failure to exhaust domestic remedies in relation to certain periods of detention.

The ECtHR examined the case primarily under Article 5.1 of the Convention, which protects individuals against arbitrary deprivation of liberty. Although this provision permits the lawful detention of persons of "unsound mind", the Court's settled case-law requires that such detention take place in a hospital, psychiatric clinic, or another institution capable of providing appropriate therapeutic care.

The Court divided the applicant's detention into two distinct periods: the first extending from 26 April to 9 July 2020, and the second from 10 July 2020 to 25 February 2021.

No violation was found in relation to the first period. By contrast, the Court held that Article 5.1 had been violated during the second period. The applicant's continued detention in an ordinary prison resulted exclusively from the absence of appropriate institutional alternatives following the legislative reform. Although mental health services had been formally activated, they were incapable of remedying the fundamentally unlawful nature of detaining an individual whose psychiatric condition had officially been recognised as incompatible with imprisonment.

The Court reaffirmed that an ordinary prison cannot become a substitute for an appropriate therapeutic institution merely because of organisational shortcomings attributable to the State.

Within the prison context, Article 3 imposes a positive obligation upon the State to safeguard prisoners' physical and mental health by providing the medical care required by their condition. In the present case, the Court found that this obligation had clearly not been fulfilled. The material conditions in which Ms Albertani was detained were considered wholly inadequate, while the psychotherapeutic treatment provided during the second period of detention was found to be manifestly insufficient. Keeping an individual suffering from severe psychiatric illness in an ordinary prison, while depriving her of the continuous specialist treatment required to preserve her dignity and health, subjected her to suffering exceeding the unavoidable level inherent in lawful detention and therefore amounted to degrading treatment.

Article 5.4 guarantees every detained person the right to challenge the lawfulness of their detention before a court capable of deciding the matter promptly, while Article 13 guarantees the availability of an effective domestic remedy for violations of Convention rights. As demonstrated by the facts of the case, the applicant was effectively prevented from exercising either of these rights. The Italian legal system failed to provide any preventive, compensatory, or otherwise effective remedy capable of reviewing the legality of her detention in light of her psychiatric condition and the acknowledged incompatibility of her imprisonment within the ordinary prison system.

The Court further found violations of Article 5.5, concerning the right to compensation for unlawful detention, and Article 6.1, relating to the right to a hearing within a reasonable time. Consequently, pursuant to Article 41 of the Convention (Just Satisfaction), Italy was ordered to pay the applicant €15,000 in compensation for non-pecuniary damage.

The significance of this judgment extends beyond the individual circumstances of the applicant and raises broader concerns regarding the Italian prison system. The ECtHR made clear that the State cannot rely upon well-intentioned legislative reforms, such as the closure of the outdated Judicial Psychiatric Hospitals, to justify a resulting gap in the protection of fundamental rights. Whenever a custodial psychiatric system is dismantled, appropriate alternatives—whether REMSs or specialised community-based mental health facilities—must be immediately available, adequately resourced, and fully operational. Structural shortages of places, bureaucratic delays, and legislative gaps cannot justify the unlawful detention of particularly vulnerable individuals in overcrowded ordinary prisons.

The judgment further consolidates the principle that mental healthcare in prison must be equivalent to that available within the community. At the same time, it raises a broader policy question as to whether a comprehensive reform of mental healthcare is needed both inside and outside places of detention, given the persistent deficiencies affecting both systems. Formal medical supervision or the administration of palliative medication alone cannot satisfy the requirements of Article 3 where individuals suffer from severe psychiatric disorders.

Finally, the judgment requires Italy, under the supervision of the Committee of Ministers of the Council of Europe pursuant to Article 46 of the Convention, to undertake structural reforms concerning the management of prisoners who develop serious psychiatric illnesses while in detention. It also requires the introduction of effective and expedited judicial remedies capable of preventing ordinary prisons from becoming de facto repositories for vulnerable individuals who remain excluded from REMSs or other appropriate mental healthcare services due to waiting lists or systemic administrative failures.

Andrea Ciotta v. Italy (Application No. 368/21)

Like the judgment discussed above, Andrea Ciotta v. Italy was delivered by the First Section of the European Court of Human Rights (ECtHR) on 4 June 2026.

The applicant, Andrea Ciotta, is an Italian national suffering from severe and clinically established personality disorders together with chronic psychiatric illnesses that significantly impair his capacity for judgment and self-determination, requiring continuous specialist treatment. Owing to criminal proceedings directly connected to his vulnerable mental condition, the Italian judicial authorities ordered the application of a custodial security measure to be carried out in a Residence for the Execution of Security Measures (REMS). However, because no places were available within the REMS system, the measure could not be enforced immediately. Consequently, the applicant was temporarily placed and subsequently detained in an ordinary correctional institution. During this period, he was deprived of the intensive therapeutic and rehabilitative treatment that his condition required, while also being exposed to the structural deficiencies that continue to affect the ordinary Italian prison system.

Mr Ciotta argued that his detention in an ordinary prison, despite the acknowledged incompatibility of his psychiatric condition with such a setting and in the absence of treatment specifically tailored to his clinical needs, amounted to inhuman and degrading treatment, causing him severe and unjustified psychological suffering. He further alleged violations of Article 5 (paragraphs 1, 4, and 5) of the Convention, maintaining that his detention was fundamentally unlawful. Having been formally assessed as requiring placement in a therapeutic institution (REMS), his continued detention in an ordinary prison violated both the principle of legality and the therapeutic purpose that must govern measures involving individuals suffering from serious mental disorders. The applicant also complained of the absence of any prompt and effective judicial review of his detention and of the lack of an adequate domestic compensatory remedy. Furthermore, he alleged a violation of Article 34 of the Convention, arguing that the Italian authorities had hindered the effective exercise of his right of individual application before the Strasbourg Court.

The Italian Government defended its conduct by referring to the organisational limitations affecting the REMS system, particularly the shortage of available places and the need to comply with waiting lists organised according to chronological priority. The Government further argued that, although detained in an ordinary prison, the applicant had nonetheless received medical attention and access to the healthcare services available within the institution. Finally, it raised preliminary objections concerning the admissibility of the application under Article 35 of the Convention, particularly with regard to the calculation of the applicable time limit following the reduction from six to four months and the alleged failure to exhaust available domestic preventive remedies. The Court either rejected these objections or joined them to the merits of the case.

The ECtHR found multiple violations of the Convention. First, it reaffirmed that keeping a person suffering from a severe and well-documented psychiatric disorder in an ordinary prison solely because of logistical constraints, namely the lack of available places in a REMS, is incompatible with respect for human dignity. The Court concluded that both the medical care provided to Mr Ciotta and the ordinary prison environment were manifestly inadequate to address his psychiatric condition, exposing him to suffering that exceeded the inevitable hardship associated with lawful detention and therefore amounted to degrading treatment in breach of Article 3 of the Convention.

The Court also found a violation of Article 5.1 concerning the applicant's detention as a person of "unsound mind". It reiterated its well-established case-law according to which the deprivation of liberty of a person with a serious mental disorder is lawful only where it is carried out in a hospital or another institution capable of providing appropriate therapeutic treatment. Once again, the Court stressed that ordinary prisons cannot and must not be used as temporary holding facilities while individuals await placement in a REMS. Administrative inefficiency or structural shortcomings cannot justify restrictions upon fundamental rights.

The Court further found violations of Article 5.4, due to the absence of a prompt judicial review of the lawfulness of the applicant's detention; Article 5.5, because domestic law failed to provide an effective right to compensation for the unlawful deprivation of liberty; and Article 6.1, on account of the lack of effective access to a tribunal within a reasonable time. The Italian legal system failed to provide Mr Ciotta with effective legal mechanisms capable of promptly terminating his unlawful detention and ensuring his transfer to an appropriate therapeutic institution, leaving him in a procedural limbo devoid of adequate judicial protection or compensation.

Furthermore, the Court held that the Italian authorities had, to some extent, obstructed or delayed the applicant's ability to communicate freely with the ECtHR and to pursue his individual application effectively, thereby failing to comply with their obligation under Article 34 of the Convention not to hinder the exercise of the right of individual petition.

Finally, pursuant to Article 41 of the Convention, the Court ordered Italy to compensate the applicant for the non-pecuniary damage suffered as a consequence of these serious violations of his fundamental rights.

Comparative Analysis: Why Do the Similarities Between the Two Judgments Matter?

Taken together, Albertani v. Italy and Andrea Ciotta v. Italy establish a clear and unequivocal principle: the unavailability of places within secure psychiatric facilities cannot justify the detention of individuals suffering from severe mental disorders in ordinary prisons. The fundamental rights to liberty and health prevail over the organisational or financial limitations of the State.

The fact that both judgments were delivered on the same day demonstrates that the ECtHR is no longer addressing isolated incidents but rather a structural and systemic problem affecting the Italian legal and penitentiary system, thereby engaging the State's general obligations under Article 46 of the Convention. Italy can no longer rely solely upon ex post monetary compensation to remedy individual violations; instead, it is required to implement comprehensive structural reforms capable of ensuring the prompt therapeutic placement of all individuals affected by serious psychiatric disorders.

Both judgments further reaffirm that prisoners with severe mental health needs constitute one of the most vulnerable groups within the prison system. For this reason, the State's positive obligations under Articles 3 and 5 of the Convention must be interpreted and applied with particular rigor. Delays attributable to administrative inefficiency or the subsequent payment of financial compensation cannot remedy violations that undermine the dignity, physical integrity, and psychological well-being of particularly vulnerable individuals deprived of their liberty.