Psychiatric nurse: care without consent, seclusion, duties and training

Admission unit, community mental health centre, mobile team, day hospital or private practice: psychiatry and mental health offer nurses a broad field of practice, where the therapeutic relationship is the primary tool. It is also a sector where the law closely regulates patients' freedom. This guide presents the settings and duties, the rules for care without consent, the framework for seclusion and restraint, and the training available to specialise.

Where do psychiatric and mental health nurses work?

The Conseil national de l'Ordre infirmier lists a wide range of practice settings:

• psychiatric inpatient units;
• community mental health centres (CMP), which are central to outpatient care;
• part-time therapeutic reception centres (CATTP);
• mobile teams, notably psychiatry-precarity teams (EMPP);
• private practice;
• school settings and occupational health, where the identification of mental health disorders is increasingly important.

What are the duties of the psychiatric nurse?

Psychiatric nursing care is based first and foremost on relationship and clinical observation. Among the activities described by the Ordre:

• welcoming the patient and their family;
• socio-therapeutic activities, individual or group-based;
• monitoring patients in seclusion rooms;
• therapeutic education and psychosocial rehabilitation;
• prevention and early identification of disorders.

These activities are part of the core competencies redefined following the Act of 27 June 2025, which established nursing consultation and nursing diagnosis. For details, see our guide on the role and competencies of the nurse.

Free care or care without consent: what is the difference?

In free care, the patient consents to their care, either alone or through their legal representative. They retain the same rights as any hospitalised patient: they can move freely and may leave, even against medical advice.

Les soins sans consentement sont l'exception. Ils supposent des troubles mentaux qui rendent le consentement impossible et imposent des soins. Le patient reste titulaire de ses droits : il est informé de sa situation et peut demander la levée de la mesure.

What are the procedures for care without consent?

At the request of a third party

The director of the establishment orders admission when the disorders make consent impossible and the patient's condition requires immediate care. This requires:

• a written request from a third party: a family member, guardian or curator, or a person with prior contact with the patient;
• two medical certificates dated less than 15 days prior.

In an emergency, admission may be based on a single certificate.

In case of imminent danger

When no third party can be found and there is imminent danger to the person's health, the director orders admission on the basis of a single medical certificate, issued by a doctor outside the establishment.

By decision of the State representative

The prefect orders admission when the disorders compromise public safety or seriously harm public order, on the basis of a medical certificate issued by a doctor outside the establishment.

How do the first days of a measure proceed?

The measure begins with an observation period of 72 hours maximum, in full hospitalisation. A medical certificate is issued within 24 hours, then another within 72 hours, to determine whether care should continue and in what form:

• full hospitalisation;
• a care programme: outpatient care, home care or part-time hospitalisation.

The measure is then maintained for renewable one-month periods. After one year, a multidisciplinary review is organised.

What judicial oversight is exercised?

All full hospitalisation without consent is subject to systematic judicial review by the district court judge before the 12th day, then every 6 months. The judge may order the measure to be lifted. The patient, a relative or the departmental psychiatric care commission may also petition the judge at any time.

Good to know: the nurse is often the one who explains the patient's rights and the course of the hearing to them. Your observations recorded in the file inform the medical certificates and, indirectly, the judge's decision: ensure they are precise.

Seclusion and restraint: what does the law say?

Seclusion and restraint are measures of last resort, taken on the decision of a psychiatrist. The law strictly limits their duration:

• seclusion: 12 hours maximum, renewable up to 48 hours;
• restraint: only during seclusion, 6 hours maximum, renewable up to 24 hours.

Beyond these periods, the measure may only continue under judicial oversight. Relatives are informed of renewals beyond the initial periods, in accordance with confidentiality requirements.

What does the HAS recommend on seclusion and restraint?

The HAS recommendations on seclusion and restraint in general psychiatry remain the reference for good practice. They recall that these measures are only considered after the failure of less restrictive alternative measures, such as a calming space whose door is not locked.

Who decides, and when?

The decision rests with a psychiatrist, from the outset or subsequently. If the measure was initiated in an emergency, it must be confirmed by the psychiatrist within the hour following its start. An interview and medical examination are carried out at the time of implementation, then at least two medical visits per 24 hours. Each measure is recorded in the patient's file and in a specific register of the establishment.

What nursing surveillance?

• Monitoring of mental state at least every hour, which may extend to continuous surveillance.
• Somatic monitoring prescribed according to risks: blood pressure, heart rate, oxygen saturation, palpation of the calves.
• Checking of attachment points, skin condition and physiological needs: this falls within the nurse's independent role.
• Access to food, hydration and hygiene, with respect for the patient's dignity.

What to do after the measure is lifted?

The HAS recommends offering the patient the opportunity to review the episode with the team. This review, recorded in the file, serves to understand their experience, to identify what might have prevented it and to identify alternatives for the future. A time for team analysis completes the approach.

Point of vigilance: each measure must be recorded with precision: reason, start time, medical decision, surveillance carried out, time of lifting. Poor traceability weakens the measure before the judge and exposes the team.

Is specific training required to work in psychiatry?

The State nursing diploma is sufficient to practise in psychiatry. The specific diploma for psychiatric sector nurses was abolished in 1992; its holders now practise like other nurses.

What changes in initial training

The new training framework, resulting from the decree and order of 20 February 2026, applies to students entering training from September 2026. According to the Order, it makes psychiatry a compulsory training field and provides for a compulsory placement in psychiatry. For access to studies, consult our guide on entry to IFSI.

Specialising: the IPA with a focus on psychiatry and mental health

Created by a decree of 12 August 2019, the psychiatry and mental health focus of advanced practice is prepared over two years, at master's level, after at least three years of practice. The IPA ensures the follow-up of patients entrusted to them and has expanded competencies in terms of prescribing and referral. Find out more in our guide on the nurse in advanced practice.

Training in violence prevention

The HAS recommends that teams be trained and drilled in violence prevention and management as well as de-escalation techniques. If you are a victim of assault, the procedures are detailed in our guide on nurse health and safety.

What place for psychiatry in private practice?

The Order identifies private practice as a full place of practice in mental health, and advocates for the development of advanced private practice in this field. At home, the nurse ensures continuity of treatment, identifies signs of relapse and liaises with the community mental health centre and the doctor. The care plan for a patient in care without consent may indeed include home care.

Official sources

• Service-public: Care for psychiatric disorders
• Justice.fr: Care for psychiatric disorders
• French National Authority for Health: Seclusion and restraint in general psychiatry, recommendations text
• French National Council of Nurses: Position and recommendations on mental health and psychiatry, Decree and order of 20 February 2026 relating to the State Diploma in Nursing