from an even more general point of view, it is necessary to highlight the feeling of vulnerability that often weighs upon patients for very practical reasons. Thus, the vast majority of rooms lack any effective locks and, at night, numerous patients fear sudden visits, probably wrongly, perhaps rightly so. It is not difficult to make provision for rooms that can be locked at the initiative of their occupants, of course without the lock being an obstacle to the admission of medical staff, with the aid of a (carefully protected) masterkey. This measure, which a few institutions have implemented, has already been called for. It has scarcely been put into effect. Similarly, in order to ensure a minimum of privacy in the rooms, a film is often placed on the external windows, which lack any shutters or blinds (and often on the ground floor), which makes them opaque from the outside. However, this inexpensive technique, apart from the fact that it reduces daylight and visibility, does not resolve the issue of the privacy necessary after nightfall, when the light in the room is switched on. Once again, this results in an impression of weakness which makes patients uneasy and, as before, causes anxiety. If security measures need to be taken, it is indeed in this area. It is surprising that, whereas scarcely any expense was spared in terms of funds for the completion of external security, internal protection is so often neglected, despite its far lower cost. In other terms, resolution of the problem posed by the feelings of anxiety suffered by patients is much more important than that arising from the possibility of a patient running away. Assuming, moreover, that the former difficulty is unrelated to the latter, which is far from being certain. Progress needs to be made on these issues. 2.5.2.2 – The Issue of Activity Similarly, progress needs to be made with regard to the issue of inactivity. Any activity in psychiatric units is of course subject to medical decision. But once this principle is granted, the question arises of the volume and nature of these activities. Even a rapid visit of most units is enough to become aware of the inactivity in which patients are kept for a great deal of their time. The areas and staff devoted to the various different possible therapies (occupational therapy, art therapy etc.) are insufficient in the vast majority of cases. As is well-known, in spite of the wishes of medical staff, outings also have to be limited, in the absence of sufficient numbers of staff. As we have already written, these shortcomings are partly attributable to the spirit in which psychiatric hospitals were designed forty years ago: that of being places for crises. They were therefore conceived as places for short stays. From this point of view, there is no need to develop activities to any great extent for patients who do not stay for long. However, this line of reasoning is questionable. On the one hand, although it is true that the average stay often comes to a few weeks, the duration is not the same for everybody. In particular, persons committed for treatment without consent in the form of full hospitalisation stay for markedly longer periods, especially patients committed to psychiatric treatment at the request of a representative of the State (formerly hospitalisation by court order) Admittedly, this is perhaps the population for which, due to its state, activities are the least easily accessible, but this circumstance cannot be erected as a general law. On the other hand, the question of activity needs to be raised with insistence in the case of “inactive” stays of longer than two months, as a means of contributing to restoring the person, when this is possible. On the other hand, subject to more general data, the assessments made by the Contrôle Général during its inspections tend to show that the average length of stays is currently increasing, which moreover explains the 61

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