drugs, persons entering the unit in an untimely manner etc. – without the effects and effectiveness thereof always having been fully considered. In the best of cases, patients can only leave their unit, in particular in order to walk around the hospital, at certain times of day and with the agreement of staff, and the intervention of the latter in order to open the door. In such a context of restriction of the liberty to come and go, it is absolutely essential for each patient to be able to have an external area at their disposal within their unit which, in most cases, is also the only place where they are authorised to smoke. Yet, this is not always the case. Thus, in one large mental health institution in the Parisian region, patients hospitalised in a unit located on the first floor cannot freely go to the large tree-lined patio, which is reserved for the unit on the ground floor. Access thereto is closed-off by bars, except at the time of meals, which are eaten in a room which is also located on the ground floor. For the rest of the time, the patients of this unit only have access to a passageway-gallery which constitutes the only external space in which it is possible to get some fresh air and have a smoke. To the feeling of suffocation and confinement is added the frustration generated by the view from the gallery of the persons hospitalised in the unit on the floor below, who can, for their part, enjoy the attractions of the patio… Neither do units relocated outside of psychiatric hospitals, and psychiatric wards established within general hospitals always have a park, courtyard or patio; patients who are smokers, in particular, are sometimes obliged to gather together, as in a controlled hospital, on balconies covered with wire mesh. Moreover, when they exist, these premises are not all necessarily laid out. Thus, in one child psychiatry hospitalisation unit inspected, the courtyard did not offer any shelter, the ground being of earth and grass: whenever it rained, which was often in this unit in the North-East of France, the young people remained on the threshold of the French window in order to avoid making their shoes dirty and, in reality, never really went outside. It is important for patients to be able to have an open air area at their disposal, if they are not in a position to leave their hospitalisation unit. The courtyard or patio needs to be sufficiently large to make it possible to go for a walk and get away, providing the possibility of sitting down and sheltering from bad weather Similarly, although courtyards need to be enclosed in order to enable free access thereto for patients receiving treatment without their consent – in particular for smoking – some are enclosed under disgraceful conditions. In one institution inspected, the courtyards of the various different hospitalisation pavilions were surrounded by and surmounted with wire mesh, in response to a demand to prevent running away, made by the director of the regional hospitalisation agency226. This arrangement, implemented in spite of the opposition of the majority of staff, consisting of green wire mesh, without trees and exposed to public view, gave a real impression of “cages”. Before any measure is taken, of a security-enforcement character which may conflict with medical treatment and fundamental rights, it appears necessary that the representatives of users, families and staff, as well as the hospital ethics committee227, which should exist, should be informed in order to give an opinion and even take part in the discussions. 226 At 1st April 2010 regional hospitalisation agencies (ARH / agences régionales de l’hospitalisation) were replaced by regional health agencies (ARS) put in place by Act no. 2009-879 of 21st of July 2009, referred to as the "Hospital, patients, health and territories" Act. 227 Ethics committees were created in application of article L.6111-1 of the Public Health Code, which provides that "Health institutions undertake internal reflection concerning the ethical questions raised by reception and medical 146