Psychiatric care without consent: duration of measures and practical consequences

Imagine: your neighbour in Saverne, Mr. D., is hospitalised without his consent in psychiatry. The prefect issued an admission order. One month passes, then three. The doctors modify his care plan: he moves from full hospitalisation to outpatient care. But does this modification reset the clock on the time limits? This is the crucial question that the Court of Cassation decided in 2022.

In essence, the law on care without consent provides for maximum durations: an initial one month, then three months, then renewable six-month periods. But when the modalities change (for example, from hospitalisation to home care), some see this as a new measure. The Court of Cassation says no: the time limits run from the start, without resetting. A decision that secures the practices of prefectures and hospitals, but may surprise patients and their families.

What to do if you are affected in Haguenau or elsewhere? This article deciphers the decision, its practical implications, and provides advice on how to assert your rights.

The facts: a story that happens every day

Mr. X, resident of Haguenau, was admitted to psychiatric care without consent by prefectural order of 2 November 2020, while he was already in a care programme for over a year. The prefect of Bas-Rhin took this decision on the basis of Article L. 3213-1 of the Public Health Code (care at the request of the State representative for immediate danger to the safety of persons). The initial duration was one month, then renewed for three months, then for six-month periods.

During the measure, the care modalities were modified: Mr. X moved from full hospitalisation to outpatient care (regular consultations at Saverne hospital). His lawyer then seized the Judge of Liberties and Detention (JLD) to have the measure declared irregular, arguing that the modification of modalities constituted a new admission, which should have been preceded by a new prefectural decision and a medical examination.

The Strasbourg JLD rejected the request, confirmed by the Lyon Court of Appeal (as the file had been transferred due to legitimate suspicion). Mr. X appealed to the Court of Cassation. The Court of Cassation dismissed the appeal, confirming that the modification of care modalities does not affect the duration of the measure. In other words, the time limits run from the initial admission, without resetting.

The reasoning of the court — dissected

The Court of Cassation relies on Article L. 3213-4 of the Public Health Code. This text provides that care without consent decided by the prefect has an initial duration of one month from the admission decision. It may be maintained for a further period of three months, then for maximum periods of six months renewable. The question was whether a change in modalities (for example, from full hospitalisation to outpatient care) interrupts this timetable.

For the Court, the answer is no. It considers that the modification of care modalities is not a new admission, but a simple adaptation of the care plan. The time limit counter does not reset. This reasoning is consistent with established case law (Civ. 1st, 19 June 2019, No. 18-21.091), which affirms that the legal durations are maximums, and compliance depends on the date of the initial decision, not subsequent changes.

However, note: this rule only applies to modifications of modalities. If the measure is interrupted (for example, lifting of full hospitalisation followed by a new admission), a new prefectural decision is necessary, and the time limits reset. In this case, Mr. X was still under the same legal regime, even though his care conditions changed.

The judges also noted that the legal time limits for ruling on the measure (JLD review within 12 days of admission, then at 6 months) had not been exceeded. The procedure was therefore regular.

What this changes for you — concretely

This decision has practical implications for patients in care without consent and their relatives.

For the patient: if you are hospitalised without your consent at Haguenau hospital, know that the time limits for judicial review are calculated from the initial admission, not from the last change of modalities. Thus, if your full hospitalisation becomes outpatient care, the JLD will only intervene at the scheduled deadlines (1 month, 4 months, 10 months, etc.). You will not benefit from a new automatic review after each modification.

For relatives: if you contest the measure, you must act quickly. The appeal against the prefectural order must be lodged within two months of its notification. And the JLD review is triggered automatically, but you can also seize the judge at any time to request discharge. undefined, I have encountered cases where families thought that the switch to outpatient care reset the clock and let the deadlines pass. Do not make this mistake.

For real estate professionals: this decision concerns you less directly, but it illustrates the importance of understanding legal time limits. By analogy, in property law, limitation periods or appeal deadlines are often strict and are not interrupted by changes in circumstances (for example, a change of tenant does not restart the limitation period for a repair action).

Concrete example: a patient admitted to Saverne on 1 January 2022. On 15 January, he switches to outpatient care. On 1 February, the first month ends. The prefect must decide on the continuation before 1 February, otherwise the measure ends. The change of modalities has no effect on this deadline.

Four tips to avoid this type of dispute

• Keep all documents: prefectural order, medical certificates, continuation decisions. Note the dates of admission and each modification. This will allow you to verify compliance with legal time limits.
• Anticipate deadlines: one month after admission, the prefect must decide on continuation. If you do not receive a decision, the measure ends automatically. Contact a lawyer as you approach this date.
• Do not confuse modification with new admission: a simple change of modalities (full hospitalisation to outpatient care) does not require a new order. However, a discharge followed by readmission after an interruption requires a new decision.
• Consult a lawyer from the start: if you or a relative are subject to a measure of care without consent, seek advice quickly. Appeal deadlines are short (2 months to challenge the order, 12 days for JLD review). A lawyer in Strasbourg or Saverne can guide you.

Further reading: related case law and developments

This decision is part of a consistent line of case law. The Court of Cassation had already ruled, in a judgment of 19 June 2019 (No. 18-21.091), that the modification of care modalities does not affect the duration of the measure, thus confirming the previous position. More recently, a judgment of 12 January 2022 (No. 21-16.045) specified that a change of place of hospitalisation (transfer from one establishment to another) also has no impact on the time limits, provided that the measure continues without interruption.

However, note: the European Court of Human Rights (ECHR) might have a different approach. In the case Rutkowski v. Poland (2018), the ECHR considered that any substantial modification of the conditions of deprivation of liberty must be surrounded by procedural guarantees. French case law therefore seems less protective. It is possible that in the future, the Court of Cassation may be required to clarify what constitutes a substantial modification, beyond a simple change of modalities.

For now, the trend is clear: French judges favour continuity of care and legal certainty of prefectural decisions. Patients must therefore be vigilant and not rely on an automatic reset of time limits.

Checklist before acting

1. Check the date of initial admission: this is the starting point for all time limits (1 month, 3 months, 6 months).
2. Note the dates of each continuation decision: the prefect must renew the measure before the expiry of each period. If not, the measure ends.
3. Identify modifications of modalities: change of hospital, switch to outpatient care, etc. These modifications do not affect the time limits, but may be challenged if abusive.
4. Consult a lawyer if you believe the time limits are not being respected or if you wish to contest the measure. A lawyer in Haguenau or Saverne can help you.
5. Act quickly: the appeal against the prefectural order must be lodged within two months of its notification. The JLD review is automatic, but you can also seize the judge directly.

Are you in a similar situation? A first 30-minute consultation with Maître Zakine (€45) can save you months of proceedings — and often much more. Book an appointment →