the effect of the documents thus drawn up. It is becoming increasingly common for certificates to be drawn up without the doctor even having met the patient: what then can be their veracity and significance? And yet, a balance has to be sought between the guarantees necessary for committal to treatment without consent and the maintenance of adequate relations between patients and medical staff. If, in the edifice of the Act of 5th July 2011, the former was given priority over the latter, this is probably less attributable to concerns linked to the deprivation of liberty than, in the context of current preoccupations with security, to fear of “precautionary” hospitalisation being brought to an end too early. This frame of mind is apparent in the treatment that the text reserves for persons having been subject to rulings exempting them from criminal liability or having been placed in units for difficult psychiatric patients – treatment which has been censured by the Constitutional Council, as we have seen. It would probably be appropriate to return to a better balance. To this end, it would be logical to recommend that the two types of treatment (committal to psychiatric treatment at the request of a representative of the State and committal to psychiatric treatment at the request of a third party) should be combined into a single procedure and, at the same time, that the principle of decision should be entrusted to a judge, as is done in many European counties. The very existence of a process aimed at establishing appropriate balance between different interests (those of patients and their families and friends; personal interests and those arising from public order) in court, in the course of a hearing whose contours should be subject to precautions, should make it possible to limit the need for medical certificates, whose number is at present manifestly excessive, without any reduction in guarantees for all that. Such is the choice that should be implemented, with adequate preparation time, in the act planned for 2013. 2.5.2 Security and Discipline in Institutions It is reassuring to note that, in all of the inspections conducted by the Contrôleur général, treatment is always the central concern in the health institutions inspected. However, security concerns quite naturally have to be taken into consideration, due to the reality of what in the jargon of these institutions are referred to as “undesirable events”, which may legitimately give rise to concerns on the part of professionals – hospitals not being exempt from forms of violence – as well as to pressures coming from outside. And yet these concerns, to a far greater extent than the treatment itself, can endanger the fundamental rights of persons. Here we will limit ourselves to expanding upon a few elements that give a general picture of the subject: they are three in number and are concerned with passive systems of precaution, the organisation of security and, finally, discipline among health workers. 2.5.2.1 “Undesirable Events” and Violence In the first place, however, it is necessary to have an understanding of the above mentioned “undesirable events”, as listed in the Contrôleur général’s inspections. In one institution in the Ile-de-France region, 216 undesirable events were reported in 2009 of which 59.7% (129) came from hospitalisation facilities161. The majority were reported by nursing staff (more than two thirds), much fewer by doctors (5.1%) and security officers (4.6%), within a short space of time after the events (80% within three days). regulatory measure has decided that assessment time cannot be counted as hospital time; this however carries the risk of severely reducing the availability of experts. 161 The other cases reported came from services outside of hospital. 68