locked and personalised restrictions apply to each patient regarding use of their personal belongings, communication with the outside world and outings; - the restrictions in post-acute care units are even more confining: limited access to internal yards, personal belongings cannot be accessed directly, some patients are kept in locked rooms day and night on a permanent basis, frequent use of restraint and medical prescriptions bearing on confinement and restraint are renewed for several months at a time, sometimes without further examination of the patient; - solitary confinement and restraint are practised in proportions never before encountered at stark odds with the rules that are commonly applied: for a hospital with 412 beds, an average of 35 seclusion rooms are occupied on a daily basis; - several patients under "post-acute care" are confined to ordinary rooms for often more than 20 hours a day, several months on end, sometimes restrained to the bed or a chair for up to 23 hours a day, sometimes for months at a time – and even years in some cases; - one unit for "agitated or disruptive patients" is particularly strict: pyjamas must be worn throughout a patient’s time in the unit, no personal belongings may be kept, confinement in rooms for at least 19 hours a day, no music allowed, etc.; - the patients detained are treated under such conditions systematically, irrespective of their clinical condition; - no medical checkups of patients placed in solitary confinement are conducted at the weekend, seven-day solitary confinement prescriptions are renewed without systematic examination of the patient. The inspectors also observed that the nursing staff and patients alike demonstrated an alarming degree of resignation as regards these practices. For these reasons, the Chief Inspector recommended that the Government: - enforce free movement of patients, with any restriction to the freedom to come and go expressly justified by the patient's clinical condition; - immediately put an end to confinement in ordinary rooms; - promptly rein in the excessive practice of confinement in seclusion rooms and restraint; - immediately halt medical decisions and prescriptions made with no prior examination of the patient; - ensure daily medical presence for a sufficient length of time in all units; - with the help of outside professionals, assess the clinical condition and treatment of all patients admitted in "post-acute care" units and the unit for "agitated and disruptive patients" so as to develop a life plan and care pathway for these patients; - swiftly improve the therapeutic activities on offer in units so as to make them available to the largest possible number of patients; - train all staff in preventing and managing critical situations. The Minister of Health and Social Affairs considered the points raised in the recommendations to be of a big enough concern to urge the management of the institution to take the corrective measures bearing on the general running and practices observed at the Ain psychotherapy centre as swiftly as possible. She also indicated that the relevant regional health agency, who was informed 41