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Psychiatric care
Verified 15 February 2022 - Directorate for Legal and Administrative Information (Prime Minister)
The conditions for admission and treatment of a person with a psychiatric disorder differ according to whether he is treated with or without his consent. Admission to psychiatric care without consent is done either by decision of the director of the institution at the request of a third party or in case of imminent danger to the person, or by decision of the prefect when the person's actions jeopardize the safety of the person or, in a serious way, public order.
What applies to you ?
Psychiatric care without consent
There are 2 admission procedures for psychiatric care. One by decision of the school director, the other by decision of the State representative (prefect).
Circumstances
At the request of a third party, psychiatric care may be provided by decision of the director of the institution where it has been medically established that:
- that the patient’s mental disorder makes consent impossible
- and that his condition requires immediate care and constant or regular monitoring.
The third party seeking care must be a family member, guardian or curator or any person who may act in the patient's interest and who has a relationship with him or her prior to the request for care.
The application must be submitted to the director of the selected institution in the form of a handwritten letter, signed and dated by the person making the application. The letter shall contain the following information:
- Name, surname, occupation, date of birth and domicile of the applicant and patient
- Clarification of the nature of the relationship between them
Please note
if the person seeking care does not know or cannot write, the request is received by the mayor, police commissioner or institutional head who acknowledges the request.
Documents to be provided
General case
The third party's application must be accompanied by 2 medical certificates of less than 15 days' duration attesting to the mental disorder of the person concerned.
Please note
the first of these certificates may not be issued by a doctor practicing in the establishment receiving the patient.
Emergency
Where there is a serious risk of injury to the patient, the director of an institution may order the admission of a sick person to psychiatric care.
This is only possible on an exceptional basis and at the request of a third party.
In this case, a single medical certificate from a doctor practicing in the establishment is sufficient.
The institutional head makes the decision to accept the person into psychiatric care only if all of these conditions are met.
Support
A period of observation and care of a maximum of 72 hours is provided in the form of a full hospitalization to allow the psychiatrist to adapt the modalities of his care as best he can. However, there is no reason why the measure should not be lifted within 24 hours if it proves to be unjustified.
If the two medical certificates issued, one within 24 hours, the other within 72 hours of hospitalization, conclude that psychiatric care must be maintained, a psychiatrist at the host institution proposes the form of care:
- Either full hospitalization
- Other forms of care including ambulatory care, home care or, if necessary, institutional stays or partial hospitalizations. In this case, a program of care will be developed.
When these 2 certificates conclude that the care needs to be extended, the director of the institution pronounces the maintenance of the care for a renewable period of one month in the form of care retained by the psychiatrist of the institution.
If the duration of care exceeds a continuous period of one year from admission, the maintenance of such care depends on a medical assessment carried out by a college. This evaluation shall be renewed annually.
The Judge of Liberty and Detention (JLD) exercises a systematic control of complete hospitalizations, at the latest on the 12th day of hospitalization, then after 6 months of continuous complete hospitalization.
The judge can decide whether or not to end the full hospitalization. If he lifts this measure, he can agree that this will not take effect until after a period of up to 24 hours, so that the medical team will establish, if necessary, a care program.
In order to help the patient heal, rehabilitate or reintegrate into society, the director of the institution may grant him short-term absences. For example:
- Excursions of up to 12 hours accompanied in particular by one or more staff members of the establishment or by a member of his family
- Unaccompanied outings of up to 48 hours
The isolation and the contention are practices of last resort. They can only be used when there is a danger to the patient or to others and on the decision of a psychiatrist. Any such use shall be of limited duration and shall be subject to strict monitoring.
The isolation measure is taken for up to 12 hours. If the patient's state of health so requires, it can be renewed under the same conditions and according to the same procedure within a limit of 48 hours in total and is the subject of 2 evaluations per 24 hours.
The restraint measure shall be taken as part of an isolation measure for a maximum period of 6 hours. If the patient's state of health so requires, it can be renewed under the same conditions and according to the same procedure within a total of 24 hours and is the subject of 2 evaluations per 12 hours.
Beyond 48 hours for solitary confinement and 24 hours for restraint, the measures may exceptionally be renewed by the doctor. The Warden of the institution must then inform the Judge of Liberties (JLD). In addition, at least one member of the patient's family, in priority his spouse, the partner linked to him by a CIVIL PARTNERSHIP or his partner, or a person who may act in the latter's interest, must be informed by the doctor of the renewal of the measures, with due regard for the will of the patient and the medical confidentiality.
Beyond 72 hours for solitary confinement and 48 hours for restraint, the director of the institution shall refer the matter to the JLD before the expiry of that period. The JLD allows the measure to be maintained or orders its release.
Beyond 2 decisions to maintain the isolation measure by the JLD, the isolation measures shall be checked every week. The Warden of the institution must enter the JLD at least 24 hours before the expiry of a period of 7 days of isolation from his last decision, that is after 6 days of isolation. The doctor informs relatives at the same rate.
Lifting of psychiatric care without consent
The measure ends in one of the following situations:
- On the decision of the director of the institution at the request of the departmental committee of psychiatric care, but also at the request of a family member, the guardian, the curator or any person reporting a relationship with the patient prior to the admission into care
- As soon as a psychiatrist in the institution certifies that the care is no longer warranted
- On the decision of the judge of freedoms and detention following his review, or seized by the public prosecutor, the patient or any person of interest to him
Please note
the director of the institution may be punished by imprisonment for one year and a fine of €15,000 if he maintains hospitalization against the advice of the JLD or the prefect.
Demand
In case of emergency and serious risk to the patient and if it is impossible to collect a request from third parties, the director of the institution may grant an admission.
It may be based on a single medical certificate attesting to this danger, drawn up by a doctor not practicing in the host institution and less than 15 days old.
Support
A period of observation and care of a maximum of 72 hours is provided in the form of a full hospitalization to allow the psychiatrist to adapt the modalities of his care as best he can. However, there is no reason why the measure should not be lifted within 24 hours if it proves to be unjustified.
If the two medical certificates issued, one within 24 hours, the other within 72 hours of hospitalization, conclude that psychiatric care must be maintained, a psychiatrist at the host institution proposes the form of care:
- Either full hospitalization
- Other forms of care including ambulatory care, home care or, if necessary, institutional stays or partial hospitalizations. In this case, a program of care will be developed.
When these 2 certificates conclude that the care needs to be extended, the director of the institution pronounces the maintenance of the care for a renewable period of one month in the form of care retained by the psychiatrist of the institution.
If the duration of care exceeds a continuous period of one year from admission, the maintenance of such care depends on a medical assessment carried out by a college. This evaluation shall be renewed annually.
The Judge of Liberty and Detention (JLD) exercises a systematic control of complete hospitalizations, at the latest on the 12th day of hospitalization, then after 6 months of continuous complete hospitalization.
The judge can decide whether or not to end the full hospitalization. If he lifts this measure, he can agree that this will not take effect until after a period of up to 24 hours, so that the medical team will establish, if necessary, a care program.
In order to help the patient heal, rehabilitate or reintegrate into society, the director of the institution may grant him short-term absences. For example:
- Excursions of up to 12 hours accompanied in particular by one or more staff members of the establishment or by a member of his family
- Unaccompanied outings of up to 48 hours
The isolation and the contention are practices of last resort. They can only be used when there is a danger to the patient or to others and on the decision of a psychiatrist. Any such use shall be of limited duration and shall be subject to strict monitoring.
The isolation measure is taken for up to 12 hours. If the patient's state of health so requires, it can be renewed under the same conditions and according to the same procedure within a limit of 48 hours in total and is the subject of 2 evaluations per 24 hours.
The restraint measure shall be taken as part of an isolation measure for a maximum period of 6 hours. If the patient's state of health so requires, it can be renewed under the same conditions and according to the same procedure within a total of 24 hours and is the subject of 2 evaluations per 12 hours.
Beyond 48 hours for solitary confinement and 24 hours for restraint, the measures may exceptionally be renewed by the doctor. The Warden of the institution must then inform the Judge of Liberties (JLD). In addition, at least one member of the patient's family, in priority his spouse, the partner linked to him by a CIVIL PARTNERSHIP or his partner, or a person who may act in the latter's interest, must be informed by the doctor of the renewal of the measures, with due regard for the will of the patient and the medical confidentiality.
Beyond 72 hours for solitary confinement and 48 hours for restraint, the director of the institution shall refer the matter to the JLD before the expiry of that period. The JLD allows the measure to be maintained or orders its release.
Beyond 2 decisions to maintain the isolation measure by the JLD, the isolation measures shall be checked every week. The Warden of the institution must enter the JLD at least 24 hours before the expiry of a period of 7 days of isolation from his last decision, that is after 6 days of isolation. The doctor informs relatives at the same rate.
Lifting of psychiatric care without consent
The measure ends in one of the following situations:
- On the decision of the director of the institution at the request of the departmental committee of psychiatric care, but also at the request of a family member, the guardian, the curator or any person reporting a relationship with the patient prior to the admission into care
- As soon as a psychiatrist in the institution certifies that the care is no longer warranted
- On the decision of the judge of freedoms and detention following his review, or seized by the public prosecutor, the patient or any person of interest to him
Please note
the director of the institution may be punished by imprisonment for one year and a fine of €15,000 if he maintains hospitalization against the advice of the JLD or the prefect.
Circumstances
Admission to psychiatric care by decision of the prefect may be ordered for persons whose mental disorders require care and endanger the safety of persons or seriously impair public order.
It is the police prefect in Paris and the prefects in the departments who pronounce this admission to psychiatric care by decree in view of a detailed medical certificate drawn up by a doctor not practicing in the host institution.
In the event of imminent danger to the safety of persons attested by a medical opinion, the mayors and, in Paris, the police commissioners, may take any provisional measure, including hospitalization, in respect of persons revealing manifest mental disorder. In the absence of a prefectural decision within 48 hours, the measure ceases to be valid.
Support
A period of observation and care of a maximum of 72 hours is provided in the form of a full hospitalization to allow the psychiatrist to adapt the modalities of his care as best he can. However, there is no reason why the measure should not be lifted within 24 hours if it proves to be unjustified.
If the two medical certificates issued, one within 24 hours, the other within 72 hours of hospitalization, conclude that psychiatric care must be maintained, a psychiatrist at the host institution proposes the form of care:
- Either full hospitalization
- Other forms of care including ambulatory care, home care, institutional stays or partial hospitalizations. In this case, a program of care will be developed.
Thereafter, when these 2 certificates conclude that there is a need to prolong care, medical certificates are issued monthly. A maintenance order must be issued before the end of the first month, then the third month, and then every 6 months, failing which the measure ceases to be valid.
The Judge of Liberty and Detention (JLD) exercises a systematic control of complete hospitalizations, at the latest on the 12th day of hospitalization, then after 6 months of continuous complete hospitalization.
The judge can decide whether or not to end the full hospitalization. If he lifts this measure, he can agree that this will not take effect until after a period of up to 24 hours, so that the medical team will establish, if necessary, a care program.
In order to help the patient heal, rehabilitate or reintegrate into society, the director of the institution may grant him short-term absences. For example:
- Excursions of up to 12 hours accompanied in particular by one or more staff members of the establishment or by a member of his family
- Exits not accompanied by a maximum of 48 hours (subject to written and reasoned opposition from the prefect of the department, known at the latest within 12 hours before the scheduled date)
The isolation and the contention are practices of last resort. They can only be used when there is a danger to the patient or to others and on the decision of a psychiatrist. Any such use shall be of limited duration and shall be subject to strict monitoring.
The isolation measure is taken for up to 12 hours. If the patient's state of health so requires, it can be renewed under the same conditions and according to the same procedure within a limit of 48 hours in total and is the subject of 2 evaluations per 24 hours.
The restraint measure shall be taken as part of an isolation measure for a maximum period of 6 hours. If the patient's state of health so requires, it can be renewed under the same conditions and according to the same procedure within a total of 24 hours and is the subject of 2 evaluations per 12 hours.
Beyond 48 hours for solitary confinement and 24 hours for restraint, the measures may exceptionally be renewed by the doctor. The Warden of the institution must then inform the Judge of Liberties (JLD). In addition, at least one member of the patient's family, in priority his spouse, the partner linked to him by a CIVIL PARTNERSHIP or his partner, or a person who may act in the latter's interest, must be informed by the doctor of the renewal of the measures, with due regard for the will of the patient and the medical confidentiality.
Beyond 72 hours for solitary confinement and 48 hours for restraint, the director of the institution shall refer the matter to the JLD before the expiry of that period. The JLD allows the measure to be maintained or orders its release.
Beyond 2 decisions to maintain the isolation measure by the JLD, the isolation measures shall be checked every week. The Warden of the institution must enter the JLD at least 24 hours before the expiry of a period of 7 days of isolation from his last decision, that is after 6 days of isolation. The doctor informs relatives at the same rate.
Lifting of psychiatric care without consent
The measure shall be terminated by decision in any of the following cases:
- Decision of the prefect when the psychiatrist of the institution notes the disappearance of the disorders in the patient
- Decision of the Judge of Freedom and Detention (JLD) on his own initiative or at the request of a relative of the patient, the patient himself or the public prosecutor
FYI
the director of the institution may be punished by imprisonment for one year and a fine of €15,000 if he maintains hospitalization against the advice of the JLD or the prefect.
Psychiatric care with patient consent
Psychiatric care is referred to consented where the patient's request for psychiatric care has been made by the patient himself or his legal representative (for minors) or by the person responsible for his protection (for adults who are subject to a legal protection measure).
The person is then said to be free psychiatric care.
The patient has the same rights (freedom to come and go, to choose his doctor, etc.) as the patient treated for another cause.
The length of the hospitalization is determined with the medical team that follows the patient.
Hospitalization is terminated by decision of the patient or psychiatrist, but the patient is free to go out even against the advice of the practitioner. In this case, the patient must sign an exit certificate against medical advice.
Rights of persons under psychiatric care
Admission to psychiatric care at the request of a third party or in case of imminent danger
Admission to psychiatric care by decision of the prefect
Penal provision for failure to respect patients' rights
Procedure before the Judge for Liberties and Detention
Isolation and restraint
Exit certificate against medical opinion
FAQ
Ministry of Health