MONITORING PSYCHIATRIC INSTITUTIONS “My experience in one psychiatric unit was that the first method used for a person who has just been admitted is a method of restraint called the “hug” or “restraint using sheets”. This method is more humane than others such as confinement, shackling or seclusion.” Carlos Portillo, MNP, Paraguay Participating monitoring bodies agreed on the need to identify how widespread these practices are in order to establish if they are used routinely and therefore part of an institution’s culture. For these bodies to be able to verify that other means (substitute measures to seclusion or restraint) have indeed been attempted and failed, each establishment must keep a register of these measures to ensure traceability, not only for independent external bodies such as NPMs but also for the authorities, or even families and users’ associations. The families must always be notified when their relative has been placed in seclusion and of the restraint measures they have been subjected to. France: register of seclusion and restraint and new remedy A law dated 26 January 2016 has implemented some of the NPM’s recommendations on the use of seclusion and restraint in France. The law stipulates that these practices should only be applied as a last resort subject to a doctor’s decision, and no longer based on a medical prescription, and that they must be recorded in a register. Seclusion is therefore now outside the scope of a medical prescription (in other words, outside the scope of an alleged therapeutic measure that is prescribed), which opens the possibility of challenging this medical decision before a judge. The effects of this recent provision have not yet been evaluated. The participants highlighted the need to identify alternative measures that respect the integrity and dignity of individuals, offer better prevention against crisis situations and break the vicious circle brought about by seclusion and restraint. These practices are often linked to a shortage of nursing staff in the institution as well 25