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The managerial project of the nursing directorate set up by an adult general psychiatric unit aims first and foremost to change practices in the field. This approach firstly involves structuring the institution's management. The project's main areas of focus are then rolled out through actions prioritising the bold, innovative dimensions of caregiving. This project highlights the skills of many nurses who demonstrate high levels of creativity in their nursing practices and management of patients., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The story of Amina, hospitalised at the Oasis at the Ain psychotherapy centre (CPA), illustrates how a nursing team can be mobilised to avoid the use of seclusion. Time, creativity and respect for the patient are key to the success of the care approach., (Copyright © 2018. Published by Elsevier Masson SAS.)

Over recent years, the psychiatric sector has endeavoured to develop community-based care. Paradoxically, the number of compulsory hospitalisations is increasing. At the same time, the legal framework is evolving and measures relating to the deprivation of liberty in the context of psychiatric care have given rise to extensive guidelines. The work of the French National Health Authority represents, in this context, a certain continuity, with regard to the legal, ethical and social discussions around restriction of liberty practices within psychiatric units. The main focus is on the prevention and management of violent outbursts., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Non-pharmacological alternatives which avoid or reduce the use of seclusion and restraint help to defuse psychological and/or physical tension to move towards appeasement. For the professional, the encounter with the patient requires questioning, reflection, availability as well as creativity. Mediation techniques such as hydrotherapy or equine assisted therapy, as well as the caregiver's general attitude, are perfect illustrations. Testimony., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Several measures relating to seclusion and restraint are included in the French public health code. The best practice guidelines of the French National Health Authority, published in 2017, define these two notions and advise on the behaviour to adopt with regard to their implementation and monitoring. Likewise, informing and supporting the patient when these measures are lifted are critical moments which the teams must also be able to manage correctly., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

With the reforms of 2011 and 2013 relating to psychiatric hospitalisation, raises the question of the suitability of modern psychiatric practice with regard to a person's recognised principles and basic rights. Achieving a balance is difficult and the Constitutional Council has joined the debate, bringing to an end any idea of compromise between safety and freedom. A decision which was made as a result of a clarification of certain regulations which have proved controversial from the point of view of individual liberties., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

The implementation of a sufficiently strict, adapted care setting provides constructive support for a move away from isolation and restraint towards new spaces of freedom. The account of the evolutive management of a patient by a nursing team in Bourg-en-Bresse, presents possible therapeutic strategies., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Freedom of movement is at the centre of contradictory challenges for the different people working in psychiatry, faced with a society demanding social regulation and safety, and the desire of institutions to provide high quality care. This freedom, and more globally the respect of patients' civil rights, are an indicator of the expected quality of care. Taking these rights into consideration does not mean neglecting safety, but attempts to put it into perspective. This article presents the clinical case of a patient., (Copyright © 2017. Published by Elsevier Masson SAS.)

Some institutions do not have an isolation room. Agitation is managed otherwise, with the idea that restraint or isolation can only be a terrible experience. The care pathway is therefore designed to favour autonomy and to limit restrictions of freedom. In this context, professionals are in constant contact with the user. Example of a unit which advocates this concept of rehabilitation., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

To move away from the clinical simplification of the term and restore its full complexity, it is possible to approach the notion of containment through the prism of psychological processuality. Beyond the theory, the caregiver's experience in their practice and in their contact with the patient can be considered on the basis of a series of standpoints which form the sphere of the "capacity of internal containment". However, containment is not the be all and end all of care. Containment has its limits and care must also be viewed as a constellation of complementary processes.

The decision to treat a patient in solitary confinement in psychiatry does not follow any protocol and is not made on a case-by-case basis. Team deliberation opens discussion and enables the group as a whole to take responsibility for clarifying what is to be supported by the team and implemented by the carer during treatment. When presented with complex situations, uncertainty can be a force when it calls upon an ethical dilemma.

In their daily practice, carers working in psychiatry are regularly confronted with the management of agitation situations. To provide care in confinement, the clinical issue must be exploited. "Confinement" methods exist as much in the mental and physical spheres as in the medicinal products field.