already pointed out that the architecture of the premises in which patients stay is not always adapted to these objectives. 107 Moreover, at the time of visits the CGLPL ascertained that, in general hospitals, funds for the renovation of premises are more often allocated to medical, surgical and obstetrics departments (MCO/ médecine-chirurgie-obstétrique) than other departments, to the detriment of psychiatry departments in particular. It is therefore difficult to build or fit out new areas for movement in these premises. It is worrying that, in one institution visited within a general hospital in Île-de-France, which lacked any grounds, patients committed without consent were obliged to remain upstairs, or go down to the cafeteria, without ever having access to the open air. Since the department is located within a general hospital, it operates under a “closed doors” regime in order, according to the remarks heard, to avoid psychiatric patients going to the central cafeteria and frightening other patients. In another institution in the Paris region, the head of the department initiated a process of reflection on opening its units. He pointed out to the inspectors that “the management of an open doors unit requires in-depth work with the doctors and medical staff, whose minds are put at rest by closure, as well as personalised therapeutic work with patients hospitalised without consent, in order to avoid the consumption of addictive products, violence in the grounds and running away”. Some units visited operate according to open methods, only restricting going out into the grounds and garden if the patient’s state makes it impossible. This autonomy of movement is nevertheless felt by certain psychiatrists to be “taking a risk” which needs to be assessed on a team basis. This remark clearly shows that, although architecture may constitute a hindrance to the autonomy patients, the margins of autonomy are above all dependent upon the decisions and practices of the medical staff, whatever the layout of the premises. Human resources constitute one of the variables stressed by institutions in order to explain the reduced autonomy of patients. The number of medical staff, whether doctors, nurses, psychologists or social workers, has been falling considerably for several years. This leads to vacant posts, which unavoidably results in a mode of organisation that limits the provision of measures other than absolutely essential treatment. Many of the social workers, who are ever fewer in number, in charge of planning patients’ adjustment in liaison with families, no longer have the time necessary for personalisation of measures of a social nature. In one institution visited, two units had one full-time social worker who, apart from the administrative work, was in a position to be able to meet patients, accompany them to their homes and advise them on their discharge plans. Conversely, in one less well-equipped institution, three of the four social workers had been recruited within the framework of fourmonth temporary employment contracts. Apart from the social precarity of their situation, they mentioned their low wages and their lack of time for meeting patients and their families and planning their discharge from hospitalisation. They were reduced to the tasks of verification and application of welfare rights, preventing the implementation of any real support promoting personal autonomy. 107 Annual Report of the Contrôleur général des lieux de privation de liberté, Architecture and Places of Deprivation of Liberty, Dalloz, Paris, 2013, p.127 124