Involuntary psychiatric care certificate in France: template and outline

An involuntary psychiatric care certificate is the document in which a doctor describes the mental state of a person they have examined. It attests that the legal conditions for care without consent are met, or are no longer met. In France, their timeline is set by the Public Health Code (articles L3212-1 onwards and L3213-1 onwards).

This page brings together the legal framework, the certificate timeline, the content recommended by the HAS (the French national health authority) and the French Medical Council, and a filled-in example with a fictional patient. It gives no clinical advice. Assessing the person's condition, danger and urgency is a matter for your own medical judgement.

The different measures

According to service-public.fr, the principle remains the person's free consent. Care without consent is an exception, regulated by law.

Care at the request of a third party (SDT)

• Decision by the hospital director.
• The disorder makes consent impossible, and the person's condition requires immediate care with medical supervision.
• A third party (family member, guardian, or someone with a prior relationship with the patient) makes a written, dated and signed request.
• Two certificates, less than 15 days old. The first cannot be written by a doctor working in the admitting hospital.

Third-party request in an emergency (SDTU)

• An exceptional procedure, when there is a serious risk to the person's integrity.
• A third-party request and a single certificate, which may come from a doctor in the hospital.

Care in case of imminent danger (SPI)

• Decision by the director, when no third-party request can be obtained and there is imminent danger to the person's health.
• One certificate less than 15 days old, from a doctor outside the hospital.
• According to MACSF (a medical insurer), the hospital must look within 24 hours for someone able to act in the patient's interest and inform them.

Care by decision of the State representative (SDRE)

• Order by the prefect (the police prefect in Paris) for disorders that endanger people's safety or seriously disturb public order.
• A detailed medical certificate, which cannot come from a psychiatrist working in the admitting hospital (article L3213-1 of the Public Health Code).
• Where imminent danger is confirmed by a medical opinion, the mayor (police commissioners in Paris) can take a temporary measure, which lapses without a prefect's decision within 48 hours.

The Medical Council template also states that certifying doctors must not be related by blood or marriage, up to the fourth degree, to each other, to the director, to the person making the request or to the patient.

The certificate timeline

The 72-hour observation period

• Within 24 hours. A doctor carries out a full physical examination, then a psychiatrist writes a certificate on the person's mental state and whether care should continue. This psychiatrist must not be one of the doctors behind the admission.
• Within 72 hours. A new examination and a new certificate. For imminent danger, MACSF specifies that this certificate is written by a different psychiatrist from the 24-hour one.
• Proposed form of care. If both certificates conclude that care is needed, a psychiatrist in the hospital proposes the form of care (full hospitalisation or a community care programme).
• Ending the measure. For a measure decided by the director, if a certificate concludes it is no longer justified, it is lifted. According to service-public.fr, the measure can be lifted within 24 hours if it proves unjustified.

Judicial review

• The judge of the judicial court, referred to in many documents as the liberty and custody judge (JLD), systematically reviews full hospitalisations.
• The director or prefect refers the case within 8 days of admission. The referral comes with a reasoned opinion (avis motivé) from a psychiatrist in the hospital.
• The judge rules by day 12 at the latest, then again after 6 months of continuous full hospitalisation.

After the first weeks

• For a measure decided by the director, it is extended for one month at a time, on the basis of new certificates.
• Beyond one continuous year, extension depends on an assessment by a panel, repeated each year.
• For a prefect's measure, monthly certificates are written. In the last three days of the first month, the prefect can extend the measure for three months, then for renewable periods of up to six months (article L3213-4 of the Public Health Code).

The outline, section by section

The law sets the timeline, not the exact content. The outline below combines the Medical Council template and the sections of the HAS memo (March 2018) on certificates and opinions at the end of the observation period.

1. Heading and legal framework

• Type of certificate (initial, 24-hour, 72-hour, monthly, reasoned opinion).
• Type of measure (SDT, SDTU, SPI, SDRE) and the Public Health Code article concerned.

2. Doctor's identity

• Name and RPPS number if possible.
• Place of work, and whether you work in the admitting hospital when this is a condition.

3. Identity of the person examined

• Title, surname, first name, date and place of birth.

4. Examination conditions

• Date, time and place of the examination.
• Whether it took place. If an interview was impossible, the reasons, and that the opinion is based on the file.
• Language used and interpreter's identity if needed.

5. Findings

• Clinical description illustrated by specific behaviour or the person's own words.
• Change since the previous certificate.

6. Need for care

• Whether the presentation calls for psychiatric care.
• The link between the disorder, its likely course and the need for full hospitalisation or a care programme.
• The severity factors you looked for, as listed in the HAS memo. Weighing them is your call.

7. Capacity to consent

• Understanding of information, reasoning, ability to express a choice and stability of that choice over time.

8. Measure-specific content

• SPI. Why the condition is a danger, why it is imminent, and how it threatens the person themselves.
• SDTU. The serious risk to the person's integrity, spelled out.
• SDRE. The disorders that endanger people's safety or seriously disturb public order, with the facts.

9. Conclusion

• Whether care is needed, and why.
• Proposed form (continued full hospitalisation, care programme, lifting the measure).

10. Date, time and signature

• Legible, in French, dated and signed.
• According to the HAS, typing is mandatory for an SDRE measure and recommended in other cases.

Filled-in example

72-hour medical certificate, psychiatric care at the request of a third party (article L3212-1 of the Public Health Code).

Doctor. Dr Paul V., psychiatrist, RPPS 00000000000 (fictional number), admissions unit of the general hospital.

Person examined. Ms Sophie T., born 4 May 1984 in Lyon. Admitted 6 October at 6.40 pm.

Examination conditions. Examined on 9 October at 2 pm, on the unit, in a one-to-one interview of about thirty minutes, in French.

Findings. Ms T. remains suspicious and keeps away from staff. She states that her neighbours "are putting microphones in the walls" and that she "has to leave before they act". She refused two meals, saying they were poisoned. She sleeps little and paces the corridor at night according to nursing notes. Compared with the 24-hour certificate, agitation has decreased, but her statements are unchanged.

Need for care. The disorders observed call for psychiatric care. Their persistence and the refusal of food justify, at this stage, continued constant medical supervision.

Capacity to consent. Ms T. understands she is in hospital but disputes needing care. She explains her refusal by the same beliefs. She is not, at this stage, able to consent to care.

Conclusion. The conditions for the measure are still met. I propose continued care in the form of full hospitalisation.

Information. Ms T. was informed of this proposal, her rights and how to appeal. She said she "will appeal".

Signed on 9 October at 2.45 pm.

Common mistakes

• Using generic wording. The HAS asks for a detailed, reasoned document for each case. A certificate that could fit anyone weakens the measure.
• Writing the diagnosis. The HAS memo advises against it, on grounds of professional confidentiality. Describe the disorder instead.
• Certifying what you did not see. Only certify what you observed yourself. Report what others say as such.
• Assuming a disorder is enough. A mental disorder alone does not justify the measure. The legal conditions must be described.
• Leaving out the time or date of examination. The legal timeline runs in hours and days.
• Getting the author wrong. Depending on the measure, the first certificate must come from a doctor outside the hospital, and successive certificates from different psychiatrists.
• Writing illegibly. The certificate will be read by the director, the prefect, the judge and the patient's lawyer.

Informing the person

The HAS memo states that the person must be told, as soon as possible, about their legal situation, their rights, how to appeal and the decisions taken, with the reasons. Their consent should be sought at all times. Note these steps and the person's comments in the record. A switch to voluntary care should be considered as soon as their condition allows, the decision resting with whoever ordered the measure.

Save time with Delta

Delta is a clinical assistant for mental health and allied health professionals. After the examination, you can dictate your findings and add written notes. Delta drafts letters, certificates and assessment reports adapted to your profession, and can give you a first draft of a certificate structured along your outline.

For these certificates, the rule does not change. The text must describe what you yourself observed, in this person, at this time. Check every statement, remove any generic wording and sign. Delta does not assess the person and does not decide anything.

Data is hosted in France by an HDS-certified provider, with AI processing in France. The patient's name and identifying details are pseudonymised before the AI step, no audio file is kept and data is never used to train a model. See what is Delta and the Delta for psychiatrists page. The trial lasts 14 days with no credit card.

Frequently asked questions

Further reading

• Medical certificates in psychiatry, the ethical framework.
• Mental status examination template.
• Psychiatric consultation report template.
• Psychiatric discharge letter.
• Psychiatrist's letter to the GP.
• All our clinical document templates.
• Choosing an AI scribe as a psychiatrist.
• AI note-taking software compared.

Sources

• Service-public.fr, care for psychiatric disorders (F761, in French).
• HAS, guidance on writing certificates and opinions at the end of the 72-hour observation period (March 2018, via AP-HP, in French).
• French Medical Council, medical certificate templates (in French).
• France Assos Santé, involuntary psychiatric care (in French).