references on "proper provision for patients as regards their fundamental rights" are rare, if not nonexistent.
With a few rare exceptions, the professionals the CGLPL works with are willing
to listen to its observations. As such, it is particularly regrettable that these
stakeholders - who are mindful of treating their patients properly - find it hard to
access the guidance or training they so clearly feel they need or come up against
institutional hurdles when trying to set up more considerate provision
arrangements. Two points illustrate these hurdles: information for patients about
their rights, and organisation of the day-to-day routine.
Information for patients about their rights has drawn criticism from the CGLPL on several
occasions, each time more or less on the same issues:
-
rights are presented in a cursory manner, either because the person presenting them is
unfamiliar with them or is not convinced they need spelling out;
-
the welcome booklet and regulations are incomplete or obsolete; in some extreme
cases they either do not exist or predate the 2011 and 2013 legislation;
-
in teaching or general hospitals, there is no specific welcome booklet for psychiatry;
-
the internal rules are not displayed in units;
-
patients are not given any prior information regarding hearings with the liberty and
custody judge.
None of these shortcomings are unfixable or too costly to put in place even. It should be
possible to resolve them by drafting standard documentation and running an ambitious training and
information campaign. Fortunately the CGLPL's reports also highlight good practices in this respect
which can be transposed: this should be arranged by the Ministry for Health.
Day-to-day life in psychiatry wards is organised on the basis of a series of prohibitions and
authorisations which vary for no convincing reason - usually on precautionary or organisational
grounds. Restrictions can thus bear on any number of aspects of daily life: being able to smoke, sexual
relations, access outdoors, the possibility of returning to one's room during the day, access to a phone
booth or mobile phone, availability of occupational activities or access for chaplains to departments.
All of these points can be subject to limitations ranging from an outright ban to authorisation within
certain time slots, or permission granted on a case-by-case basis by a member of nursing staff - often
based on his or her own availability.
And yet, in other institutions, there are no real restrictions regarding any of that: risks
associated with mobile phones or their chargers are managed differently than by an outright, blanket
ban, visits are authorised unless there are medical grounds to the contrary, patients are free to spend
time alone in their room, go out to a patio for a smoke, manage their own cigarettes or go to the
cafeteria when they want - including when they have been committed involuntarily. Only medically
justified restrictions that have been discussed with the patient in question are applied. This results in
less stressed environments within departments where the nursing staff are more available as they are
not constantly being called on to make exceptions to general prohibitions.
The most restrictive practices are nevertheless nearly always subject to internal debate - often
to do with the discussions in place on the right to come and go. The diversity of practices within the
same institution can, in this respect, be beneficial: indeed, the finding that those wards practising the
most flexible types of provision do not have more problems than the others cannot but challenge
views. On this point, as with information for patients, what is missing the most is references. It would
therefore be highly advisable for the Ministry for Solidarity and Health to issue guidance, organise
training and distribute good practices. The CGLPL can help it in these efforts.
13
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