There were nearly 75,000 involuntary psychiatric commitments in Spain in 2025, according to the latest data from the General Council of the Judiciary (CGPJ). This is an instrument of last resort, in the hands of psychiatrists, that requires judicial authorization and that has always been surrounded by controversy: poorly regulated and also poorly applied. The European Court of Human Rights has ruled against Spain for not respecting the guarantees of a man, who was placed in a psychiatric hospital without providing him with an adequate legal defense. Added to this is that the national legislator has ignored the mandate of the Constitutional Court to develop article 763 of the Civil Procedure Law, which includes involuntary confinements for reasons of mental health, through an organic law.
In this context, the Ministry of Health has promoted a legal reform, which will come into force on October 23, and which toughens the prerequisites for psychiatrists to decree a forced admission of patients with serious mental health problems. In accordance with this new regulation, which includes Law 4/2026, involuntary psychiatric admission is reduced to situations of "vital urgency."
"The reform seeks to strengthen the protection of the rights of mental health users and give greater security to professionals in their clinical practice," declared Belén González, Commissioner of Mental Health of the Ministry of Health, in response to questions from this medium.
But, for now, what this reform does seem to have achieved is to greatly anger psychiatrists, who have prepared a note in which they make clear their opposition to the regulatory change and, in addition, warn about its immediate consequences for psychiatric patients and their families.
Which patients are left in limbo with the new regulations?
The Spanish Society of Psychiatry and Mental Health (Sepsm) has raised the alarm over article 13 bis of Law 4/2026, of October 1, published in the BOE, on October 3, the only one of this law that refers to mental health. It considers that limiting forced admission to a "vital emergency" leaves "without coverage patients with serious conditions such as psychosis with abandonment of self-care, bipolar disorders in severe manic episodes, serious eating disorders or high-risk suicidal ideation without an immediate plan."
"Protecting those who, in the midst of a crisis, cannot protect themselves also means respecting their rights. Without clear criteria and without alternative resources, this law will leave many patients and their families alone," Sepsm points out.
And the criticism of this reform also extends to the legal engineering used. Which is no small thing. Psychiatrists warn of the "legal uncertainty" generated by this regulation and its contradictions regarding the concept of "vital risk" that they must observe to apply the measure, since the norm includes different definitions.
What does the concept "life risk" mean and how should it be applied?
It's not just psychiatrists who say it. "Law 4/2026 itself defines vital urgency in two different ways, once again placing health professionals on the threshold of uncertainty," says Carmen González Carrasco, professor of Civil Law and counselor responsible for training in MBE Legal. This situation generates, according to the jurist, "a new source of added legal uncertainty for psychiatrists."
At Sepsm they are aware of this situation and have highlighted it, reiterating that there are two definitions of vital urgency that do not coincide: "one protects the life and integrity of the person; the other, only life." They add that, in addition, this limitation on the use of the forced entry measure "collides with article 9.2.b of Law 41/2002 on Patient Autonomy, which allows action in the event of a serious risk to physical or mental integrity."
To this insecurity "are added new demands for already overwhelmed services," according to Sepsm. The scientific society explains that "the psychiatrist on duty must document the specific events that pose a risk to life, the voluntary alternatives offered and exhausted, the support and advance directives consulted and the information on rights given to the patient. Each containment will become a security incident that must be notified and analyzed."
Having to document all of these aspects by law "will mean that psychiatrists will need dedicated attention time for these activities, which will further increase staffing needs." They state that, in this new situation, "scheduled admissions due to progressive deterioration are, in practice, prohibited." The psychiatry societies that accompany the Sepsm in signing the note against the reform warn "of the risk of defensive medicine, more discharges from the emergency room and more readmissions in worse conditions."
Faced with the panorama described by psychiatrists, the Mental Health Commissioner of the Ministry of Health defends the new model as "more guaranteeing" in the protection of patients and "gives security to those who care for them." It explains that "article 13 bis [Law 4/2026] specifies the guarantees and health conditions that must accompany these interventions: verify that voluntary alternatives have been exhausted, identify the support that the person needs to decide in accordance with the framework of Law 8/2021 and consult if there are prior instructions, advance decision planning or a crisis plan." And he adds that "it must be guaranteed that the person receives accessible information about their rights and the guarantees of the procedure."
He points out that to make this change effective, "administrations must provide services with resources, tools and procedures that improve the quality of care and allow for the promotion of voluntary, non-coercive and community interventions.
On the other hand, Law 4/2026 once again insists on the reform of confinement by establishing, in its nineteenth final provision, the obligation of the Government to send to the Cortes Generales, within a maximum period of one year from the entry into force of the law, a draft Organic Law to reform article 763 of the Civil Procedure Law, which includes non-voluntary confinement due to mental disorder.
However, while this is happening (or not), psychiatrists consider that this reform has been done without debate and without including them or the patients. And they ask, among other issues, for "clear instructions from the State Attorney General's Office and coordination with the confinement courts, before October 23, to guarantee a homogeneous criterion throughout the territory", for the implementation of these new requirements in psychiatric confinements.
