Hospitalization without assent in France

This article describes the situation in France, for the general situation, to see Hospitalization without assent

When a person is not able to exert her assent and that its hospitalization is necessary, one carries out a hospitalization without assent . This definition does not relate to the case of an unconscious victim , its hospitalization raising then of the urgency. In the majority of the democracies, the hospitalization without assent is an emergency regulation, since the patient must normally be associated with the therapeutic step and exclude any possibility of arbitrary internment.

The typical case of hospitalization without assent is a mental Trouble preventing the person from dealing with itself, or inducing a dangerous behavior for itself or its entourage. In certain cases, concerning the minors, the hospitalization without assent can be ordered for purely somatic reasons, for example if the parents oppose the care of their child per religious conviction or philosophical whereas the life of this minor is threatened by this decision.

Old texts

  • Decree 16 August 24th, 1790 on the legal organization: “The objects of police force entrusted to the vigilance and the authority of the municipal bodies are: The care to obviate or cure the annoying events which could be caused by foolish or the furious ones left in freedom, and by the divagation of the animals malfaisants or wild”
  • the law of June 30th, 1838 defines the methods of the voluntary placement and the placement of office. According to Louzoun ( Legislations of mental health in Europe ), before to this text, the Civil code French on the matter gave competence to the legal authority (the internment resulting from a procedure of Interdiction), but in practice it was especially the police force and the families which made the decision. The circular of the Minister of Interior Department of September 17th, 1804 on the reclusion of foolish warns against the abusive arrests by the prefects and recalls that detention requires a judgment caused by the family.

The current Public health code

In France, the hospitalization without assent is governed by the law n° 90-527 of June 27th, 1990 (modified by the law “Kouchner” of March 4th, 2002 relating to the rights of the patients and the quality of the health system), which replaced the law of 1838. These texts are included in the L3212-1 articles and following and L3213-1 and following of the Public health code.

In addition to the free hospitalization (HL), these texts define in a restrictive way the field of application of measurements of hospitalization without assent which comprises two methods:

  • the hospitalization at the request of a third (HDT, old " placement volontaire")
  • the hospitalization of office (HO, old " placement of office").

The circular “Veil” n° 48 DGS/SP3 of July 19th, 1993 recalls that: “ the law n° 90-527 of June 27th, 1990 relating to the rights and the protection of the people hospitalized because of mental disorders (Article L 326-2 of the public health code) gives to these in-patients freely the same rights as those which are recognized with the patients hospitalized for another cause. Among these rights appears that to go and come freely inside the establishment where they are neat; this fundamental freedom cannot thus be called into question acting people who agree themselves to receive psychiatric care. Admittedly the rules of procedure can envisage particular methods of operation of a service, but these methods, whose patient must be informed, could not call into question this principle. ” Dr. Bantman quotes cases of restriction on the freedom of going and coming, the Esquirol hospital, for patients in HL or HSC: risk of exit without authorization of patients hospitalized under constraint, risk of “intrusion” of foreign people to the service with an aim especially of traffic of Stupéfiant S or alcohol, Démence with ambulation among disorientated patients, risk of running away of an autistic patient , threat of suicide.

According to the Council of State (stop Bush, October 18th, 1989, N° 75096), “a major person presenting of the signs of mental disease, can be retained against her liking in an establishment of hospitalization only during time strictly necessary to the setting in euvre of measurements of internment of office or voluntary placement, envisaged by the public health code”.

An exemption from the general principle of the assent necessary of the patient

The law of March 4th, 2002 recalls that the assent with the care by the patient remains the principle essential to very dealt with therapeutic. The recourse to the hospitalization under constraint must thus remain an exception which is strongly framed. There exists a certain blur on the bond between the hospitalization without assent and the possibility of imposing a medical care, noting the Strohl report/ratio for example: “ In logic of what was exposed in connection with the assent in psychiatry, the national group regarded the hospitalization without assent as a treatment. It can be applied in precise cases, définis.
But the statute of hospitalized without assent should not involve de facto a presumption of assent to the other acts carried out during this période.
Certes the law of 1990 is not very explicit as for the connection between treatments and hospitalization without assent, it amalgamates them when it defines the HDT, like meeting a need for immediate care and of a constant monitoring. It is imagined indeed that all is included/understood in these terms: nerve sedatives, electric shocks, enfermement in unit even closed in room of insulation.
In this direction it should be reaffirmed that the assent with the treatment must be the rule, and the hospitalization like the treatment without the agreement of the patient an exception duly framed by medical reasons having to allow the doctors and the patients to better manage mental pathology together . ”

An administrative commission, the departmental commission of the psychiatric hospitalizations (CDHP), and the civil and administrative courts are charged to take care that the maintenance at the hospital of the patient is carried out in the respect of the laws and raises neither of arbitrary nor of the abusive retention.

The composition of the CDHP is specified in the law of March 4th, 2002, the decree n° 2006-904 of July 19th, 2006 and circular DGS/SD6C n° 2005-88 of February 14th, 2005. Under the law, each CDHP is composed:

  • Of two psychiatrists, one indicated by the public prosecutor close the Court of Appeal, the other by the representative of the State in the department;

  • Of a magistrate appointed by the first president of the Court of Appeal;
  • Of two representatives of respectively approved associations of sick people and families of people reached of mental disorders, indicated by the representative of the State in the department;
  • Of a general doctor appointed by the representative of the State in the department.
  • In the event of impossibility of designating one or more Members of the Commission mentioned in this article, of the personalities of the other departments of the area or the departments bordering can be named.

Hospitalization at the request of a third (HDT)

The hospitalization at the request of a third is a hospitalization which is carried out without the assent of the patient, at the request of a third, i.e. of a member of its family or of a person who carries interest to him. This third must justify relations former at the request of HDT, which prohibits the intervention of “false third” such as social workers acting at the request of a doctor or administration); failing this, the judge can pronounce cancellation (THIS 12/3/03 CHS of Caen, n°244867) and the suspension (MT Versailles, judge of the summary procedures, Catherine K.C prefect of the Hauts de Seine, June 30th, 2006) of the hospitalization.

To define the need for a HDT the articles L 3212-1 and following and L 3213-1 and following of the Public health code refer to:

  • the presence of mental disorders;
  • impossibility, by the patient, to grant his hospitalization;
  • need for immediate care supplied with a constant monitoring in hospital medium.

For the emergency HDT, the texts introduce the concept of imminent danger, i.e. of serious risk of degradation of the state of the person in the absence of hospitalization.

Modes of enforcement of the HDT

  • the third is defined like any person likely to act in the interest of the patient, i.e.:
    • a member of his family or her entourage;
    • another person being able to justify existence of relations former at the request of hospitalization, other than medical staffs since they exert in the establishment of reception.
  • Formulation of the request of the third:
    • the request must be handwritten, on paper plain and signed by the person applicant. The law specifies that if this person cannot write, the request can be received by the Maire, the Police superintendent or the director of the establishment which gives notice of it. This request must comprise the names, first names, profession, age and residence of the person applicant like person which one asks for the hospitalization. The request must specify the nature of the relations between the person applicant and that which is the subject of the request and, possibly, their degree of relationship.
  • Doctor's certificates:
    • It is necessary that two doctor's certificates of less than 15 days are joined at the request of HDT.
    • the Médecin S which establish the certificates should be neither parents neither allied between them, neither with the director of the establishment entitled to receive the patients hospitalized without their assent, neither with the petitioning third nor with the patient.
    • the first certificate cannot be established by a doctor exerting in the establishment of reception of the patient. The second certificate is not bound by the observations or the conclusions of the first.
    • the doctor's certificates must be written in French language, to comprise the name, first name, function of the doctor writer. They must be written in simple terms by avoiding the technical terms and the diagnostic assumptions because these certificates are not covered by the medical secret.
    • Each doctor must examine and to note itself the mental disorders presented, the discussion with the patient is thus obligatory. When the patient cannot be approximate or approached (exceptional cases) the doctor must specify it.
    • the certificates must be addressed to the director of the establishment of reception.
  • In the event of imminent danger , and only in this case, the director of the establishment can pronounce the admission within sight of one only emanating doctor's certificate of a doctor of the establishment of reception but in this case the certificate must reveal the immediacy of the danger to the health or the life of the patient. The request for a third remains essential then.

The requirement of two certificates constitutes in theory an important guarantee, but it would be circumvented (for example in the event of impossibility of finding a second doctor):

  • by an abusive recourse to the procedure of imminent danger (which requires only one certificate)
  • by the late drafting (after the admission) of the one of the two certificates
  • by a spirit of mutual trust between the doctors, which would encourage them, when they are supposed to establish the second certificate, automatically to confirm the conclusions of the first doctor (or to recopy its certificate textually).

Circular DGS/6 C n° 2000-564 of November 20th, 2000 relating to the management report of the departmental commission of the psychiatric hospitalizations for the year 1999 fact state of a “abusive vulgarizing” of the procedure of imminent danger, which would be due to the following reasons:

“ - better mental apprehension of the health issues by the general doctors and the families as well as a better knowledge of the device of care in psychiatry;
- difficulty for the families of obtaining a second doctor's certificate;
- modification of the profile of the people concerned: people committing suicide or dependant with the toxic products;
turbid of violent behavior;
- increase in the HDT urgently initiated by the emergency services of the CHG ”

Case of the minors

They are not the subject of a HDT, but the holders of the parental authority can hospitalize them against their liking.

Hospitalization of office (HO)

The hospitalization of office (HO), governed by the articles L 3212-1 and following and L 3213-1 and following of the Public health code is defined according to two methods:

  • Apart from the urgency:

    • HO is pronounced by decree of the prefect of police with Paris, or by the prefect in the other departments, within sight of a detailed doctor's certificate.
    • the methods of the drafting of this certificate are the same ones as those required for the doctor's certificates necessary to the HDT. It must specify that the mental disorders of the patient require immediate care and compromise way engraves the safety of the people and the law and order.
    • This certificate cannot be written by a psychiatrist exerting in the establishment of reception of the patient.

  • In emergency:

    • In the case of an immediate danger for the safety of the people, attested by a medical opinion or, failing this, by public notoriety, the mayor or, in Paris, the police superintendent, can order in urgency temporary measures (which do not constitute a HO according to MT Paris, October 30th, 2002, n° 006413, Groupe Information Asylums, AJDA 2003, IR p. 254). In Paris, in this case, detention takes place with the psychiatric Infirmerie of the police headquarter (in the past “special infirmary of the deposit” or “special infirmary close the police headquarter”), located at the hospital Holy-Anne.
    • In this case the law does not impose a doctor's certificate but a simple opinion. A doctor can be elected by the mayor or a police superintendent to write it as soon as the situation allows it. This certificate must mention that the patient, by his behavior, constitutes an imminent danger to the safety of the people or the law and order.

HO must be justified in right and, the motivation being able to be contained in the decree itself or the doctor's certificate which justifies HO (THIS; Circular DGS/SD 6 C n° 2001-603 of December 10th, 2001 relating to the motivation of the orders of the prefect of hospitalization of office).

Schedule provisional placement of the judge of the children within the framework of the educational welfare

Article 375-3 of the Civil code lays out: “ If it is necessary to withdraw the child of its current medium, the judge can decide to entrust it: With a service or an sanitary institution or of education, ordinary or specialized ”

Article 375-9 of the Civil code lays out: “ the decision entrusting the minor, on the base of the 3º of article 375-3, with a receiving establishment of the people hospitalized because of mental disorders, is ordered after detailed medical opinion of a doctor external with the establishment, for one duration not being able to exceed fifteen days.
measurement can be renewed, after medical opinion in conformity of a psychiatrist of the establishment of reception, for one one month duration renewable. ”

Transport of the patient

The article L3222-1-1 CSP, such as it results from the law nº 2004-806 of August 9th, 2004, lays out that the people in HDT or HO can be transported to the health care institution of reception without their assent and when that is strictly necessary, by means adapted in their state, transport being ensured by a medical conveyer approved under the conditions laid down the articles L. 6312-1 with L. 6312-5. In the case of a HDT, transport can take place only after the establishment of at least a doctor's certificate and the drafting of the application envisaged with the articles L. 3212-1 and L. 3212-3.

Recourse of the patient and monitoring of his state

Gaps in the information of the patient besides

  • According to Cecile Prieur, “Generally, the patients are unaware of their right to resort to the control of the administrative or legal judge”.
  • According to Assia Boumaza and Thierry Fossier, the dissatisfied users do not believe what the administration says to them, the booklet of reception is neglected by all, the charter of in-patient is posted but not read, and the CDHP is unable to provide complete information.

Recourse jurisdictional

The patient can dispute the need his hospitalization in front of the Juge of freedoms and detention (since; previously, it was the president of the Court of Bankruptcy which was qualified). The judge of freedoms and detention can maintain the hospitalization without assent, or order the exit. The patient can also dispute the legality of the HSC in front of the administrative court by means of a recourse for abuse of power. In theory, the JFD judges the need for the HSC, while the administrative judge examines his formal regularity (for example, the competence of the authority which made the decision and the respect of the procedure); the courts of the legal Ordre are qualified for any compensation request including those which are founded on a formal irregularity noted by the administrative judge. The question of the exact distribution of competences between the two orders of jurisdiction gave place to a rather important jurisprudence (see for example EC, 1 {{er}} April 2005, Mrs. L., n°264627, AJDA n°22/2005, chronic pp. 1231-1234).

For the group of evaluation of the law of 1990 (Strohl commission), “in theory it is true that a judge, seat, would be appointed better to make a privative decision of freedom for a patient, in all independence, compared to the opinion, with managed, the family and the health-care system”, but there would be two disadvantages:

  • the difficulty in ruling in the near future, with the risk that, without closer examination of the file, the judge is satisfied to validate the opinion of a doctor or administration
  • it would have there no more separation between the authority which would make the initial decision and that which examines the recourse against this decision (it would be difficult for a judge to declare abusive an internment ordered by another judge, and even if the second judge were completely independent of the first, it would not be inevitably regarded as such by the patient)

Alvaro Gil-Robles, police chief with the Human rights of the Council of Europe, estimates that, like any loss of liberty, the HDT or HO can be established only by one judge and not by the only administrative authority, except with regard to the provisional decisions made in an emergency (report/ratio at the Committee of the Ministers and the Parliamentary Parliament on its visit in France from September 5th to 21st 2005).

Visits of the establishments

The prefect or his representative, the judge of the magistrates' court, the president of the Court of Bankruptcy or its delegate, the mayor of the commune or his representative, and the public prosecutor have the legal requirement visit regularly the services of psychiatry accommodating of the patients hospitalized under constraint (Article L333-2 CSP). However, it happens that this rule is not complied with:
  • Circular DGS/SP 3 n° 99-300 of May 25th, 1999 relating to the management report of the departmental commission of the psychiatric hospitalizations for the year 1998 notes that “the " CDHP" stress that their work compensates, in general, the absence of application of article 332-2 which envisages an annual visit of the mayor, prefect and public prosecutor in all the establishments aimed to the article L. 331 of the CSP”
  • about UMD of Montfavet, the European Comité of prevention of torture noted in his report/ratio on its visit in France from October 27th to November 8th, 1991: “It is finally to raise that the audit processes envisaged by the law are frequently deprived of effectiveness. The visits of the authorities of supervision are rare and appear without practical repercussion. ”
  • According to the Strohl report/ratio, “the majority of the evaluations deplore that the visits of the authorities in the establishments entitled to receive people hospitalized without their assent, envisaged with the article L. 332-2, are not really paid”

Monitoring of the patient and certificates established during the hospitalization

The doctor who follows the patient must establish certificates of 24:00, of fortnight… When that is considered to be necessary by the doctor, of measurements of closed rooms or insulation can be prescribed. This measurement implies a card of monitoring Infirmière which must be filled several times per day. The patient must be considering each day by the doctor.

The European Committee of prevention of torture noted in his report/ratio on its visit in France from October 27th to November 8th, 1991, about a UMD: “ In the files, the certificates of situation and the periodic reports/ratios obligatory is generally reduced to some stereotyped formulas, without true renewed examination of the patient. The particularly weak equipment as a medical personnel, taking into account the severity of the cases dealt with, is obviously at the origin of this situation, to what the weakness of the medical secretariats is added. ”

According to circular DGS/SP 3 n° 99-300 of May 25th, 1999: " " CDHP " as a whole note that one of the most important encountered difficulties relates to the monthly certificates justifying the maintenance of a measurement of hospitalization under constraint: those are often too repetitive and not very detailed in time especially when they are hospitalizations without assent of long life. The question of the legitimacy of the maintenance of measurements of hospitalization under constraint concerned arises thus. "

Consequences of the hospitalization

The facts having given place to the hospitalization without assent, if the author is regarded by justice as “attein, at the time of the facts, of a mental health disorder or neuropsychic having abolished its understanding or the control of its acts”, are not the object penal sanctions (Article 122-1 of the Penal code), although they can give place to a compensation for the victim by their author (article 489-2 of the Civil code). These measurements medical and administrative do not appear in the Police records (but the people hospitalized without their assent can be registered with the Fichier HOPSY, which makes it possible the administration to give to them an special attention within the framework of certain procedures, such as the examination of the applications of Port of weapon). In addition, the hospitalized people of office must be examined by a psychiatrist approved before obtaining to them Permis to lead; however, in general, “At her exit of the establishment, any person hospitalized because of mental disorders preserves the totality of her rights and duties of citizen, subject to the provisions of articles 492 and 508 of the civil code, without its psychiatric antecedents being able to be to him opposite” (Article L3211-5 CSP).

Changes of modes of hospitalization

According to the state of the patient, the modes of hospitalizations can be modified:
  • In certain difficult situations where the conditions of hospitalization are not adapted any more, a person in free hospitalization can be put under HO HDT even. In the same way a person in HDT can be put out of HO if the circumstances require it (for example, request by a third to raise HDT against the opinion of the doctor, or escape from the patient requiring the HO passage to start research).
    • Article L3212-9 CSP lays out: “ With regard to the people concerned with a hospitalization on request of a third, and if their mental state requires care and compromises the safety of the people or carries reached, in way engraves, with the law and order, the representative of the State in the department can take a provisional decree of hospitalization of office. In the absence of confirmation, this measurement is null and void at the end one fifteen days duration. ”.
    • Article L3212-9 CSP allows, in the event of opposition of the doctor to the end, required by a third, HDT, the delivery by the prefect of a provisional deferment (valid fifteen days to the maximum), possibly followed by a HO, which makes it possible to maintain the patient in the hospital.

  • For the HO people, a transfer in UMD (Unit for difficult patients) can be carried out in the event of particular dangerosity.

  • On the other hand, as soon as its state allows it a person in HDT can return to the mode of the free hospitalization following a simple medical decision, whereas the passage of a HO placement in free service can require an administrative authorization in addition to the medical opinion.

Epidemiologic data

A report/ratio of the European commission (Central Institute off Mental Health - cf bibliography for the references and criticism ) analyzing the compared legislations of the various countries of the European Community relating to the hospitalization without assent shows the great variability of this measurement according to the countries. The variability of the legislations makes the comparison difficult but starting from the data collected (between 1997 and 2000 according to the countries) it appears that one obtains the following rates:
  • In Portugal 6 hospitalizations without assent for 100.000 inhabitants is 3,2% of the psychiatric hospitalizations;
  • In France 11 hospitalizations without assent for 100.000 inhabitants, which accounts for 12,5% of the psychiatric hospitalizations (or approximately 100 HSC for 100.000 inhabitants according to Bernardet and Barbato, for which Salize made a miscalculation);
  • In Finland 218 hospitalizations without assent for 100.000 inhabitants what accounts for 21,6% of the psychiatric hospitalizations;
  • In Sweden this rate of hospitalization without assent reaches 30% of the psychiatric hospitalizations.
This same report/ratio notes that in France there exists, since 1992, a tendency to the increase in the number of measurements of hospitalizations without assent.

Head office of health (circular DGS/6C N) 2004/237 of May 24th, 2004) which tries to analyze this situation puts forth several assumptions which could explain this situation:

  • a more frequent recourse to the psychiatric care which is noted by the growth of the active file of the sectors in psychiatry;
  • the fact that the available data give an account of measurements taken and not of the patients themselves; a person being able to be hospitalized several times of continuation this increase in the hospitalizations without assent would show especially that the hospitalization of certain patients is too short and that they leave before being sufficiently stabilized:
  • the social precarisation of certain numbers of patients which influences their psychic state;
  • the possibility that certain doctors have recourse to a HDT to make sure that their patient obtains well a place in services which lack place;
  • the role of the services of reception of urgencies (SAU) in the establishment of the certificates of HDT.

Moreover, one speaks about a “psychiatrisation of the company” consisting in for example hospitalizing people in situation of great marginality who rather need a lodging than of care, or regarding as patients of the authors of sexual offenses (Strohl report/ratio, § 7.1). But one notes also an opposite tendency, consisting in regarding the mentally ills as delinquents or criminals: “" We returned two centuries behind, in times when one mixed delinquent and sick mentaux" , estimates Cyrille Canetti, psychiatrist with the prison of Fleury-Mérogis” (quoted by C.Prieur, “prisons overflowed by the surge of mentally ills”, '' Le Monde ''). Betty Brahmy, psychiatrist with SMPR of Fleury-Mérogis, estimates (Report/ratio submitted in the name of the board of inquiry on the situation in the French prisons, National Assembly, June 28th, 2000) that:

  • when an defendant suffers from mental disorders (of which the intensity does not justify that he is regarded as irresponsible pursuant to article 122-1 of the Penal code), sworn sitted “are frightened by the clinical picture which is presented to them” and can consequently pronounce a heavy sorrow;
  • it is difficult for the psychiatrists of SMPR to place their patients in a psychiatric hospital, because of a share of the lack of means of the hospitals, in addition security issues and possibilities of escape;
  • if an expert concludes in favor of penal irresponsibility, it is likely to find the person continued as patient in the hospital where it exerts, which it does not wish inevitably.

The Court of Auditors, in his report/ratio for the year 2000, estimates that “the increase in the hospitalizations on the request for a third - + 45% in 7 years -, would deserve to be the subject of deepened investigations, in order to determine if the system envisaged by the law of 1990 is adapted, provided the rules are observed, and if it does not allow drifts prejudicial the rights of the people. ”

The Député Georges Hage deposited on February 25th, 2004 a motion for a resolution tending to creation of a board of inquiry on the progression of the number of psychiatric internments in France (and with the “exploration of the tracks for the installation of an health system mental guaranteeing quality of the care, public safety and individual freedom”); it was rejected on May 12th, 2004 by the commission of the cultural, family and social affairs which considered that the increase in the HSC was over-estimated and that the multiplicity of the speakers in the procedure constituted a guarantee against the abuses.

Case of the prisoners

Under D398 article of the Criminal procedure code:

“The prisoners reached of the mental disorders aimed to the article L. 342 of the public health code cannot be maintained in a pénitentiaire.
establishment Within sight of a detailed doctor's certificate and in accordance with the legislation in force, it belongs to the prefectoral authority to make proceed, as soon as possible, with their hospitalization of office in an health care institution entitled in accordance with the article L. 331 of the code of health publique.
Il is not made application, in their connection, of the rule posed with the second subparagraph of article D. 394 concerning their guard by a personnel of police force or gendarmerie during their hospitalization. ”

Reform proposals

  • Action plan for the development of psychiatry and the promotion of the mental health (Philippe CLERY-MELIN, Viviane KOVESS, Jean-Charles PASCAL, September 15th, 2003) (pp.73-78)
  • of the national group of evaluation of the law of June 27th, 1990 (“Strohl Commission”, 1997)
  • Assia Boumaza, “Plea for the " judiciarisation" dispute of the psychiatric hospitalization”, notes under CAA Paris, March 23rd, 2005, n° 01PA0267, Gaz.Pal. July 13rd and 14th 2005, pp. 7-14
This author is in favor of the “judiciarisation”, i.e. of the legal judge nomination, instead of the administration, like competent authority to order a HSC. The judiciarisation would have the following advantages:
  • “the intervention preliminary of the legal judge to any hospitalization without assent to make sure a priori of the cogency of measurement by means of an psychiatric evaluation”
  • “the organization of a debate with access to the personal file and the motivation of measurement”
  • obligatory assistance of a council
  • faculty to request a counter-evaluation
  • the conformity of the French right:
    • in article 38 of the Constitution, which indicates the legal authority like “guardian of individual freedom”
    • with the theory of the block of competence
    • to recommendations of the Council of Europe:
      • recommendation n° 1235, relating to psychiatry and the human rights, 1994
      • recommendation R (83) 2 on the legal protection of the people reached of mental disorders and placed like involuntary patients of the Committee of the Ministers for the Council of Europe, February 22nd, 1983

  • Reform proposals of the law of June 27th, 1990, report/ratio presented by A. Lopez and I. Yeni (IGAS) and Mr. Valdes-Boulouque and F. Castoldi (IGSJ), May 2005

  • Relative bill with the prevention of the delinquency, deposited with the Senate on June 28th, 2006

Conclusion

Even imperfect, these very strict provisions framing the hospitalizations without assent grant certain guarantees to the patients and must prevent the arbitrary or abusive internments. It is in This spirit which the law provides that with each hospitalization, a booklet clarifying the principal terms defining its administrative statute is given to the patient and his family. This booklet also presents the grounds for appeal which are accessible.

In general, the families are obviously not prepared to face the restriction of freedom which represents for the patient and his close relations a first hospitalization under constraint. For this reason the law envisages in the booklet of reception a presentation of the patient's rights and the existing grounds for appeal. Certain patients and professionals think that these textual provisions offer, in practice, few guarantees (for example, for Clément, looking after them tend not to give following the requests of the patients to contact a lawyer, and can even laugh at this request, whereas this law is explicitly envisaged by the law of 1990).

There exist also association S of defense of the patients who ask for other evolutions of the hospitalization without assent. As always, in democracy, the law must arbitrate between several sometimes contradictory points of view:

  • the Individual freedom of the patient who is compromised, on the one hand by the measurement of loss of liberty, on the other hand by the mental disorders which affect it;
  • the concern of the family of the patient or his close relations of protecting it from arbitrary or, on the contrary, protecting themselves;
  • need for protecting the Law and order;
  • the point of view of the professionals of psychiatry who have sometimes another appreciation of the situation of the patient that itself or his family.

See too

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