The CGLPL first and foremost considers that these are practices which seriously infringe
on fundamental rights, their therapeutic effectiveness is unproven and they appear to be the result
of a shift in the way people suffering from mental disorders are dealt with. It finds that there is a
contradictory approach among the hospital community as regards these practices which, although
applied in diverse ways, are carried out in almost all institutions. The indications concerning use of
solitay confinement are diverse, but often problematic; a framework drawn up in 1998 by the
National Health Evaluation and Accreditation Agency (ANAES, now the National Authority for
Health/HAS) does not stop abusive practices or, in particular, the application of protocols with no
bearing on the patient's clinical condition. The conditions for implementing restraint and solitary
confinement are disparate and it is impossible to put a figure on how often they are carried out. As
far as restraint is concerned, this practice strikes as particularly worrisome because of i ts "insidious
use" and because the careful medical surveillance it requires is not in evidence at all times.
In all cases, irrespective of the situations and conditions in which both practices are carried
out, serious violations of rights are reported: medical treatment and somatic care are sometimes
insufficient, safety is not always ensured, the right to privacy is flouted, the right to receive visitors
is not always respected, the right to dignity is violated, the physiological needs for physical mobilit y
are not always sufficiently taken on board and activities are virtually non-existent.
The lack of collective discussion between professionals has prevented standards from being
developed, which has left broad scope for medical arbitrariness in a context where safety is at stake.
There is no shared vision of what constitutes freedom for patients: because the psychiatric
profession as a whole is not giving thought to their right to move around freely, there is no justified
basis for any measure to inspect or prevent abusive practices. What is more, such disinterest is
surprising given the impact these practices have on human resource management: they are not being
institutionally studied in their environment and for their professional impact, when their cost in
terms of human resources is not insignificant.
Although it is not the CGLPL's place to determine the therapeutic relevance
of restraint in practice, it finds that these measures violate the fundamental
rights of the people subjected to them. Whilst acknowledging that a physical
restraint measure may be used under exceptional circumstances for a strictly
limited period of time limit, the CGLPL therefore considers that efforts must
immediately be made to reduce the use of solitary confinement and restraint
measures. It welcomes the fact that the Act of 26 January 2016, referred to as
"modernising the French health service", requires psychiatric institutions to
undertake a policy aimed at limiting the use of solitary confinement and
restraint.
This encouragement could remain as nothing more than a pious vow however, and to ensure
it does not, the CGLPL recommends coming up with prevention measures that particularly entail
developing the capacity to handle situations that are veering out of control and setti ng up "deescalating" strategies. For that, consideration of and training in the other possible alternative
practices are necessary, the nursing teams need to be supported and preventive measures looked
into. Moreover, on the subject of the use of solitary confinement and restraint, there needs to be a
qualitative and quantitative assessment and the dissemination of recommendations and good
professional practices. Finally, an external inspection is necessary.
To conclude, the CGLPL, bearing in mind the principle that any deprivation of liberty is a
breach of fundamental rights, makes the following detailed recommendations:
-
solitary confinement and restraint in patient's own rooms must be prohibited;
-
the requirement to wear pyjamas and have any personal belongings confiscated while in
seclusion rooms should not be systematic;
43
Select target paragraph3
Connect to a paragraph
Connect to an entity
Disable highlights
Add to table of contents