concerned 8,542 people in 2012, had climbed to 19,518 people by 2015. The creation of involuntary care at home in 2013 has also contributed to the rise in their number. The CGLPL's inspections corroborate this trend. It is not uncommon for involuntary committals to reach 40% of total hospital committals. In one extreme case - admittedly for a very small ward (with fewer than forty beds) - involuntary committals hovered around the 65-80% mark of total number of hospital committals depending on the year. In another facility, hospital committals on the grounds of imminent danger accounted for 48% of all sectioned patients. The CGLPL's observations therefore confirm the findings of the aforementioned study especially the attribution of the rise in number of involuntary committals to the committal procedure on imminent danger grounds, and more particularly decisions of this type taken by hospital accident & emergency (A&E) departments. Professionals on the ground also claim this phenomenon to be driven partly by problematic access to the community psychiatric services provided by psychological medical centres. Through close monitoring of patients, these can apparently play a preventive role one that is sometimes not provided. This means that patients in the grips of mental health crises are turning up at A&E and sectioned - without the emergency services being able to identify a third party to request committal. 1.2.2 The use of "care programmes" can conceal situations that are as restrictive as a hospital committal Stipulated in Article L 3211-2-1 of the Public Health Code, care programmes are a model for involuntary psychiatric care delivery which does not involve full-time hospitalisation, but can come in "any other form, potentially involving outpatient care, home-based care […] and, where applicable, hospital care at home, part-time committal or short-term to full-time committals within a facility." In this case, "a care programme is drawn up by a psychiatrist in the home facility which may only be amended - to factor in changes in the patient's condition - under the same conditions. The care programme defines the types of care, how often and where it is to be administered." Patients are informed about the drafting or amendment of a care programme, and their comments gathered. Restraint must not be used during care programmes. They do not come under the scrutiny of the liberty and custody judge. During its inspections, the CGLPL has often observed care programmes whose contents are so restrictive that they can hardly be differentiated from involuntary hospital committal associated with a few permissions to leave. As such, in one institution inspected in 2017, almost all of the care programmes were defined as follows: "Full-time hospitalisation c) associated with: - Permission to leave on a weekday (less than 12h), - Permission to leave at weekends (48h max.), The patient shall be accompanied by a member of her family during these outings". In this institution, whilst, according to some claims, there are times when these care programmes are set up just before the hearing with the liberty and custody judge solely to avoid having to travel to hearings being held in another hospital, it seems that, in most cases, it was a question of unfamiliarity with the legislation and the role of care programmes. In another institution, hospitalisation is the rule rather than the exception in the care programme, the practical advantage of which is not to avoid scrutiny by the liberty and custody judge but simply to limit the burden of red tape that repeated requests for 48-hour releases would generate. 15