are practices to be used as a last resort and clearly sets out an objective of regulating and reducing such practices. In accordance with this text, on 29 March 2017 the Ministry of Social Affairs and Health published an Instruction on the policy for reducing solitary confinement and restraint practices within authorised psychiatric health institutions designated by the Director-General of the Regional Health Agency for providing involuntary psychiatric treatment. This text reiterates the objective of reducing the use of solitary confinement and restraint practices and particularly mentions the criteria adopted by the European Committee for the Prevention of Torture (CPT) and by the CGLPL. It makes clear that they may only be decided for the purposes of protecting the patient or the people in his/her environment, reiterates the necessary role of the physician in the decision to use them and stipulates the physical conditions of their implementation. It also defines the conditions bearing on the traceability and monitoring of these measures within the institution, regional health agency (ARS) and central administration. This text, the draft for which was submitted to the CGLPL to give its opinion, lays down a suitable framework for applying Article 72 of the Act of 26 January 2016 on modernising the French health service. But it has still not been sufficiently taken on board by hospitals. During inspections, the following anomalies were observed: - prescriptions written in advance, with solitary confinement recommended "when necessary", are used, which means that it is for the nursing staff to decide whether or not to use such practices, at strict odds with the terms of the law. However, the team does not have the same freedom when it came to ending the measure - which can only ever be decided on when a psychiatrist is in attendance; - the decision to renew solitary confinement is made hastily without examining the patient; - preliminary efforts to find suitable alternatives to solitary confinement are insufficient, such that the practice cannot seriously be considered "a last resort" as provided for by the law; - seclusion rooms seldom comply with the recommendations of the CGLPL or CPT: call button accessible to the patient confined, clock visible from the bed, wash area accessible to the patient without needing assistance, direct human surveillance, double access to the room, no furniture that could pose a risk; - a few institutions have no documented protocol on the use of solitary confinement and restraint, or the only protocols they do have are out-of-date and unknown to the nursing staff. - several institutions also practise solitary confinement in an ordinary room, which usually deprives the patient of the guarantee of an official protocol and organised surveillance; - the somatic physician does not attend to a patient placed in solitary confinement, nor sometimes even to a patient in restraints; - although there is an official record and traceability of solitary confinement and restraint measures, it is not possible to use these in a satisfactory manner for an inspection or to develop a reduction policy; - the hospital's medical information department provides data but this is not processed; 18

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