Care for psychiatric disorders

Circumstances

At the request of a third party, psychiatric care may be provided by decision of the director of the institution. For this, it must be medically noted:

• That the mental disorders of the patient make his consent impossible
• And that his condition requires immediate care and constant or regular monitoring.

The third party requesting care must be:

• A family member
• The guardian or trustee in charge of a personal protection measure
• Or any person who may act in the patient's best interests and who has a relationship with the patient 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.

This letter must contain the following information:

• Surname, first name, occupation, date of birth and domicile of the applicant and the person concerned
• Clarification of the nature of the relationship between them.

Documents to be provided

The rules vary depending on whether it is an emergency or not:

Support

A period of observation and care of a maximum of 72 hours is provided in the form of a complete hospitalization to allow the psychiatrist to adapt the modalities of his care as best as possible. However, there is nothing to prevent the measure from being lifted within 24 hours if it proves to be unjustified.

If the two medical certificates issued, one within 24 hours and the other within 72 hours of hospitalization, conclude that psychiatric care must be maintained, a psychiatrist at the receiving institution proposes the form of care:

• Either full hospitalization

• Other forms of care that include ambulatory care, home care or, if necessary, institutional stays or partial hospitalizations. In this case, a care program will be developed.

When these 2 certificates conclude that it is necessary to extend care, the director of the institution decides to maintain care for a renewable period of one month in the form of care chosen 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 by a college. This evaluation is renewed every year.

The judge of the judicial court shall carry out a systematic review of the 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 act that this lifting will take effect only after a period of up to 24 hours, so that the medical team establishes, if necessary, a program of care.

To promote the patient's recovery, rehabilitation or reintegration into society, the director of the institution may provide short-term discharge.

Examples:

• Excursions of up to 12 hours accompanied in particular by one or more members of the staff of the establishment or by a member of its family

• Unaccompanied outings of up to 48 hours.

Isolation and restraint are practices of last resort. They can only be used in case of danger to the patient or others and on the decision of a psychiatrist. This possible use is of limited duration and subject to strict monitoring.

The measure of isolation is taken for a maximum of 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 the limit of 48 hours in total and is subject to 2 evaluations per 24 hours.

The restraint measure is taken as part of an isolation measure for a maximum 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 the limit of 24 hours in total and is subject to 2 evaluations per 12 hours.

Beyond 48 hours for solitary confinement and 24 hours for restraint, the measures may be renewed by the doctor on an exceptional basis. The director of the institution must then inform the court.

In addition, at least one member of the patient's family, primarily his or her Civil partnership partner or partner, must be informed by the doctor of the renewal of the measures, in accordance with the patient's wishes and medical confidentiality.

Beyond 72 hours for solitary confinement and 48 hours for restraint, the director of the establishment shall refer the matter to the judge before the expiry of that period. The judge authorizes the measure to be maintained or orders its release.

Beyond 2 decisions by the judge to maintain the segregation orderHowever, the monitoring of isolation measures is weekly. The warden must refer the matter to the judge at least 24 hours before the expiry of a 7-day period of segregation from the date of the last decision, that is, after 6 days of segregation. The doctor informs the relatives at the same rate.

Lifting of psychiatric care without consent

The measure ends in one of the following situations:

• By decision of the director of the institution at the request of the departmental committee for psychiatric care, but also at the request of a family member, guardian, curator or any person reporting relationships prior to admission to care with the patient

• As soon as a psychiatrist in the institution certifies that the care is no longer justified
• On the decision of the judge following his control, or seized by the public prosecutor, the patient or any person with interest.

Request

In the event of an emergency and a serious risk to the person and if it is impossible to collect a request from a third party, the director of the institution may grant admission.

It can be based on a single medical certificate attesting to this danger, written by a doctor not practicing in the host institution and dated less than 15 days.

Support

A period of observation and care of a maximum of 72 hours is provided in the form of a complete hospitalization to allow the psychiatrist to adapt the modalities of his care as best as possible. However, there is nothing to prevent the measure from being lifted within 24 hours if it proves to be unjustified.

If the two medical certificates issued, one within 24 hours and the other within 72 hours of hospitalization, conclude that psychiatric care must be maintained, a psychiatrist at the receiving institution proposes the form of care:

• Either full hospitalization

• Other forms of care that include ambulatory care, home care or, if necessary, institutional stays or partial hospitalizations. In this case, a care program will be developed.

When these 2 certificates conclude that it is necessary to extend care, the director of the institution decides to maintain care for a renewable period of one month in the form of care chosen 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 by a college. This evaluation is renewed every year.

The judge of the judicial court shall carry out a systematic review of the 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 act that this lifting will take effect only after a period of up to 24 hours, so that the medical team establishes, if necessary, a program of care.

To promote the patient's recovery, rehabilitation or reintegration into society, the director of the institution may provide short-term discharge.

Examples:

• Excursions of up to 12 hours accompanied in particular by one or more members of the staff of the establishment or by a member of its family

• Unaccompanied outings of up to 48 hours.

Isolation and restraint are practices of last resort. They can only be used in case of danger to the patient or others and on the decision of a psychiatrist. This possible use is of limited duration and subject to strict monitoring.

The measure of isolation is taken for a maximum of 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 the limit of 48 hours in total and is subject to 2 evaluations per 24 hours.

The restraint measure is taken as part of an isolation measure for a maximum 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 the limit of 24 hours in total and is subject to 2 evaluations per 12 hours.

Beyond 48 hours for solitary confinement and 24 hours for restraint, the measures may be renewed by the doctor on an exceptional basis. The director of the institution must then inform the court.

In addition, at least one member of the patient's family, primarily his or her Civil partnership partner or partner, must be informed by the doctor of the renewal of the measures, in accordance with the patient's wishes and medical confidentiality.

Beyond 72 hours for solitary confinement and 48 hours for restraint, the director of the establishment shall refer the matter to the judge before the expiry of that period. The judge authorizes the measure to be maintained or orders its release.

Beyond 2 decisions by the judge to maintain the segregation orderHowever, the monitoring of isolation measures is weekly. The warden must refer the matter to the judge at least 24 hours before the expiry of a 7-day period of segregation from the date of the last decision, that is, after 6 days of segregation. The doctor informs the relatives at the same rate.

Lifting of psychiatric care without consent

The measure ends in one of the following situations:

• By decision of the director of the institution at the request of the departmental committee for psychiatric care, but also at the request of a family member, guardian, curator or any person reporting relationships prior to admission to care with the patient

• As soon as a psychiatrist in the institution certifies that the care is no longer justified
• On the decision of the judge following his control, or seized by the public prosecutor, the patient or any person with interest.

Circumstances

Admission to psychiatric care by decision of the prefect may be ordered for a person whose mental disorders require care and endanger the safety of persons or seriously undermine public order.

It is the prefect of police in Paris and the prefects in the departments who pronounce this admission to psychiatric care by order in the light 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 a person revealing obvious mental disorders.

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 complete hospitalization to allow the psychiatrist to adapt the modalities of his care as best as possible. However, there is nothing to prevent the measure from being lifted within 24 hours if it proves to be unjustified.

If the two medical certificates issued, one within 24 hours and the other within 72 hours of hospitalization, conclude that psychiatric care must be maintained, a psychiatrist at the receiving institution proposes the form of care:

• Either full hospitalization

• Other forms of care that include ambulatory care, home care or institutional stays or partial hospitalizations. In this case, a care program will be developed.

Subsequently, when these 2 certificates conclude that it is necessary to extend care, medical certificates are issued every month. A maintenance order must be made before the end of the 1^er month, then the third month, then every six months, otherwise the measure ceases to be valid.

The judge of the judicial court shall carry out a systematic review of the 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 act that this lifting will take effect only after a period of up to 24 hours, so that the medical team establishes, if necessary, a program of care.

To promote the patient's recovery, rehabilitation or reintegration into society, the director of the institution may provide short-term discharge. Examples:

• Excursions of up to 12 hours accompanied in particular by one or more members of the staff of the establishment or by a member of its family

• Unaccompanied outings of a maximum duration of 48 hours (subject to a written and reasoned opposition from the prefect of the department, known at the latest within 12 hours before the scheduled date).

Isolation and restraint are practices of last resort. They can only be used in case of danger to the patient or others and on the decision of a psychiatrist. This possible use is of limited duration and subject to strict monitoring.

The measure of isolation is taken for a maximum of 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 the limit of 48 hours in total and is subject to 2 evaluations per 24 hours.

The restraint measure is taken as part of an isolation measure for a maximum 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 the limit of 24 hours in total and is subject to 2 evaluations per 12 hours.

Beyond 48 hours for solitary confinement and 24 hours for restraint, the measures may be renewed by the doctor on an exceptional basis. The director of the institution must then inform the court.

In addition, at least one member of the patient's family, primarily his or her Civil partnership partner or partner, must be informed by the doctor of the renewal of the measures, in accordance with the patient's wishes and medical confidentiality.

Beyond 72 hours for solitary confinement and 48 hours for restraint, the director of the establishment shall refer the matter to the judge before the expiry of that period. The judge authorizes the measure to be maintained or orders its release.

Beyond 2 decisions by the judge to maintain the segregation orderHowever, the monitoring of isolation measures is weekly. The warden must refer the matter to the judge at least 24 hours before the expiry of a 7-day period of segregation from the date of the last decision, that is, after 6 days of segregation. The doctor informs the relatives at the same rate.

Lifting of psychiatric care without consent

The measure shall be terminated by decision in one of the following cases:

• Decision of the prefect when the psychiatrist of the institution notices the disappearance of the disorders in the patient
• Decision of the judge of liberty and detention (JLD) on his own initiative or at the request of a family member of the patient, the patient himself or the public prosecutor