Chapter II: Health establishments responsible for psychiatric care without consent.

I.- Seclusion and restraint are practices of last resort and may only be used on patients in full hospitalisation without consent. They may only be used to prevent immediate or imminent harm to the patient or others, on the basis of a reasoned decision by a psychiatrist and only in a manner that is appropriate, necessary and proportionate to the risk, after assessment of the patient. Their implementation must be subject to strict somatic and psychiatric surveillance, entrusted by the establishment to health professionals designated for this purpose and recorded in the medical records.

The isolation measure is taken for a maximum period of twelve hours. If the patient's state of health so requires, it may be renewed under the conditions and in accordance with the procedures set out in the first paragraph of this I, up to a maximum total duration of forty-eight hours, and shall be assessed twice every twenty-four hours.

The restraint measure is taken as part of a seclusion measure for a maximum period of six hours. If the patient's state of health so requires, it may be renewed, under the conditions and in accordance with the procedures set out in the same first paragraph, for a maximum total period of twenty-four hours, and is subject to two assessments every twelve hours.

II. - In exceptional circumstances, the doctor may renew the isolation and restraint measures beyond the total periods stipulated in I, in compliance with the conditions stipulated in I. The director of the establishment shall immediately inform the liberty and custody judge of any renewal of these measures. The liberty and custody judge may take action of his own motion to put an end to these measures. The doctor shall inform at least one member of the patient's family of the renewal of these measures, giving priority to the patient's spouse, partner in a civil solidarity pact or cohabitee, or a person likely to act in the patient's interest if such a person is identified, in compliance with the patient's wishes and medical confidentiality.

The director of the institution shall refer the matter to the liberty and custody judge before the expiry of the seventy-second hour of isolation or the forty-eighth hour of restraint, if the patient's state of health makes it necessary to renew the measure beyond these periods.

The liberty and custody judge shall rule within twenty-four hours of the end of the periods provided for in the second paragraph of this II.

If the conditions set out in I are no longer met, the judge shall order the measure to be lifted. In this case, no new measure may be taken before forty-eight hours have elapsed since the measure was released, unless new factors arise in the patient's situation which make it impossible to adopt other care arrangements to ensure his safety or that of others. The director of the institution shall immediately inform the liberty and custody judge, who may take action of his own motion to put an end to the new measure.

If the conditions set out in I above are still met, the liberty and custody judge will authorise the continuation of the seclusion or restraint measure. In this case, the doctor may renew the measure under the conditions set out in the said I and the first two paragraphs of this II. However, if the renewal of a seclusion measure is still necessary after two decisions to maintain it have been taken by the liberty and custody judge, the matter must be referred to the judge at least twenty-four hours before the expiry of a period of seven days from his previous decision and the doctor must inform at least one member of the patient's family of the renewal of these measures, giving priority to the patient's spouse, partner in a civil solidarity pact or cohabiting partner, or a person likely to act in the patient's interest if such a person can be identified, while respecting the patient's wishes and medical confidentiality. The liberty and custody judge shall give a ruling before the expiry of this seven-day period. If necessary, the matter shall be referred to the judge again at least twenty-four hours before the expiry of each new seven-day period and a decision shall be taken under the same conditions. The doctor repeats the above information each time the matter is referred to the liberty and custody judge.

For the application of the first two paragraphs of this II, when a seclusion or restraint measure is taken less than forty-eight hours after a previous seclusion or restraint measure has ended, its duration is added to that of the seclusion or restraint measures that preceded it.

The same first two paragraphs apply when the doctor takes several measures whose cumulative duration over a period of fifteen days reaches the durations provided for in the said first two paragraphs.

Seclusion and restraint measures may also be subject to review by the liberty and custody judge pursuant to IV of article L. 3211-12-1.

A decree by the Conseil d'Etat shall specify the conditions for the application of this II.

III.-A register shall be kept in each health establishment authorised to provide psychiatric care and designated by the Director General of the Regional Health Agency to provide psychiatric care without consent in application of I of article L. 3222-1. For each seclusion or restraint measure, this register mentions the name of the psychiatrist who decided on this measure, an identifier for the patient concerned, as well as their age, their mode of hospitalisation, the date and time the measure began, its duration and the names of the healthcare professionals who supervised it. The register, drawn up in digital form, must be presented, at their request, to the departmental commission for psychiatric care, to the Contrôleur général des lieux de privation de liberté or his delegates and to members of parliament.

Each year, the institution draws up a report detailing the practices for admission to seclusion and restraint rooms, the policy defined to limit the use of these practices and an assessment of its implementation. This report is forwarded to the Users' Committee provided for in article L. 1112-3 and to the Supervisory Board provided for in article L. 6143-1, for their opinion.