2.2 The diversified restrictions imposed on the daily routines of hospitalised patients are sometimes lacking in any therapeutic basis and can constitute unjustified unequal treatment. Over and above the freedom-restricting practices that solitary confinement and restraint constitute, during each of its missions the CGLPL also examines the measures taken to enable patients, during their hospitalisation, to benefit from a freedom to come and go that is as complete as their state of health will allow. Only the consideration of care to be administered to patients or security measures required by each patient's individual behaviour can justify any restriction of this freedom. As a result, the latter should not result from organisation measures, practical constraints or general, systematic and impersonal safety measures. In other words, although a given patient's clinical condition can justify that he or she be deprived of his or her liberty, this reason cannot be cited as grounds for all of the patients around him or her also to be deprived of their liberty. This principle is not generally contested, and yet the CGLPL found during its visits that closed units were predominant. For example, in two large institutions, only one unit was open. In another, the choice was made to opt for open units "so as not to stigmatise" patients cared for in a closed unit: units are therefore adjustable in theory, and can be closed on a provisional basis when justified by a patient's clinical condition; that said, practices differ and most units are kept permanently closed, with nursing staff only opening the door at the request of patients with permission to leave. In other places, because of the history specific to a particular institution, there are no closed units, nor even enclosure walls, and patients are free to go out – into town if they wish – whatever their status; in this institution, patients make regular outings, including those who had been committed without their consent; the legal hospitalisation system does not weigh upon the care arrangements and the prefect has never formally objected to such practices. Similar differences are apparent in the management of other liberties, including those bearing on correspondence, possession of a mobile phone, use of a computer and online access, smoking or enjoying sexual relations. In these areas, the inspectors observed a disparity that is not grounded in the differences in patient pathologies or even in the way premises are laid out, but simply in the "institutions' way of doing things" or in the, at times implicit, choices of the nursing staff. The differences observed from one institution to another, and even from one department to another, are so stark that the CGLPL believes they cast doubt over equal access to healthcare for all. When the least restrictive practices in terms of freedom are adopted, no unfortunate consequences are observed: this therefore makes a good many prohibitions observed elsewhere appear entirely unjustified. Through their ethics committee or ad hoc commissions, some institutions have initiated an original approach to considering the freedom to come and go. This involves examining any recommendation to restrict this freedom, questioning its grounds and, where applicable, looking for means of achieving the desired end result via less restrictive methods. On an occasional basis, a similar approach might also be developed for other freedoms, such as the use of mobile phones or right to smoke. It therefore appears quite possible, and advisable, for a process to be adopted within every institution for giving consideration to the grounds for each type of restriction to patients' freedom. Such processes, at times lacking in any real formal framework, are a solution to an almost constant concern on the part of nursing staff, and yet they are difficult to organise. Left to local initiative, they sometimes struggle to come to fruition through lack of incentive or reference. It therefore seems entirely worthwhile taking an initiative at national level, within the context of the 26