It also underscored the merits of calling on an external professional to run monthly
supervision sessions with the nursing staff, which the Minister of Health intends to highlight in the
context of furthering the assessment of the first instalment of the UHSA programme.
Recommendations
The CGLPL had first and foremost recommended for team stability to be improved. The Minister of
Health mentions measures taken to that end, but it is regrettable she does not provide information
about how effective they have been.
A key difficulty for the institution concerned the management of incidents, especially in
relations between the nursing staff, prison authorities, administrative authorities and the justice
departments. This difficulty seems to have been resolved by multiprofessional working groups
organised under the impetus of the prefect and regional health agency, monthly meetings between the
care teams and prison authority teams and exercises simulating incidents involving patients-inmates.
Recommendations had been issued on improving transportation of patients and medical
admission outside working hours, collecting and recording patients' comments and improving the
procedure for notifying admission orders and decisions from the liberty and custody judge. The
Minister replied that the rules of procedure have been updated and an admission procedure "in
degraded mode" is in place for weekends, and that patients' comments are now collected and
traceability of decisions concerning them is now ensured. The CGLPL duly notes this point.
The CGLPL is also interested to note that, to bring professional practices into line with the
HAS recommendation on solitary confinement and restraint, an internal audit of all the seclusion
rooms in the institution of the hospital to which the specially-equipped hospitalisation unit is attached
has been performed. The CGLPL's recommendation on alarm devices in the seclusion rooms was
apparently taken on board during this audit. In this regard, the CGLPL gives a reminder of the
recommendations about seclusion rooms that it made in its May 2016 report entitled Solitary
confinement and restraint in mental health institutions.
Lastly, several of the CGLPL's recommendations laid bare the coordination difficulties
between the two departments, the hospital and the prison authorities, whose approaches can
sometimes be conflicting or in competition. This first and foremost concerned the conditions and
scope of the prison mission within the specially-equipped hospitalisation unit, with the risks in terms
of an interruption in the treatment process and reduction in patient rights that a temporary discharge
from the penal institution can entail. It also had to do with specific rights, such as visiting rights, the
confidentiality of telephone interviews and personalising restraint measures taken during external
movements and transfers. It is regrettable that there has been no response forthcoming from the
Minister of Justice on these difficulties, to which the Minister of Health says no solutions have yet
been found.
48
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