Healthcare institutions Solitary confinement and restraint53 Patients' rights Medical decision Medical decision Monitoring and surveillance Any decision to use solitary confinement or restraint must be documented in the patient's file: the institution must be able to provide proof of the fact the measure was taken as a last resort. The information collected by the institutions must be consolidated regionally and nationally, which requires the creation of a coherent and integrated information system. The person concerned must be informed the moment a decision to use solitary confinement or restraint has been made and given written material specifying their rights and the treatment and support methods brought about by this measure. This information must also be displayed in the seclusion room. The means for appealing against the solitary confinement or restraint measure must be stipulated within each institution and displayed in all seclusion rooms as well as on the written material notifying rights which is handed out to the patient. They must be communicated to the trusted person, the parents of a minor or to any relative informed at the patient's request. The medical decision to use a solitary confinement or restraint measure can only be taken after an actual psychiatric medical examination of the person, taking into account, as far as possible, the opinion of the members of the nursing staff team. The decision must be justified on the basis of the "suitable, necessary and proportionate" nature of the measure; information on the patient's clinical condition at the time of the decision must be clearly presented. The decision must specify what had previously been tried in vain in order to justify that it is taken as a last resort. As soon as the measure has been taken, the health professionals involved in the treatment of the patient concerned must search, as part of a multidisciplinary framework, for ways of bringing it to an end as soon as possible. No decision regarding physical restraint can be taken in anticipation or with the indication "if needed". The duration of the physical restraint measure must be as short as possible and should not exceed the crisis situation; in any case, prolonging the solitary confinement measure over 24 hours and the restraint measure over 12 hours should not be possible, without a new, equally justified, decision being made, with the reasons set out as before. 53 2 2 2 2 2 2 2 2 2 2 These recommendations come from the thematic report entitled "Isolement et contention dans les établissements de santé mentale" (Solitary confinement and restraint in mental health institutions), Dalloz, 2016. 158