However, these events do not exclusively involve security problems: just over a fifth (forty-five events) involved the security of property and persons, of which twenty-four are described as physical or verbal assault. Of course, it is possible that not all assaults (in particular verbal assaults) are reported. However, it is impossible to estimate a rate of under-reporting. In any case, these twenty-four assaults have to be placed in the context of the number of patients: in the same year, the hospital in question accommodated a flux of 1,020 patients, of which two thirds were freely hospitalised and 28 % were committed to psychiatric treatment at the request of a third party (the inspection took place prior to the Act of 5 th July 2011), while the remainder were hospitalised by court order. The number of assaults in relation to the number of persons accommodated is in the region of 23.5 per thousand. In another institution inspected in 2011, 124 undesirable event forms were completed in the first half-year of 2010. Out of the fifty-eight forms for the first quarter analysed by the risk detection group set up within the institution, two involved injuries or risks of injury, four involved intrusions or risks of intrusion and two involved thefts. The institution in question has one hundred and fifty beds. In a third institution in the East of France, accommodating around 2,700 patients every year, between seventy-five and one hundred “undesirable” events manifested in assaults against staff are recorded each year (ninety-nine in 2008; sixty-eight in 2009; ninety-one in 2010). Verbal assaults account for 15% to 20%. The remainder is for the most part made up physical assaults. There was one sexual assault in 2008. Another approach may be taken by means of industrial accidents, which are carefully recorded in the vast majority of cases. In one unit for difficult psychiatric patients accommodating forty patients (but which in the course of the year in question operated with about twenty patients for a period of five months), thirty-seven industrial accidents were declared in 2008; of which thirty-two were linked to violent acts on the part of patients (that is to say one industrial accident of this kind every eleven or twelve days), for a staff of around eighty persons. However, without playing down the difficulty of the events that caused them, this high frequency of accidents should not be understood to imply dramatic events: none of the accidents led to sick leave. For the most part, they involved scratches or bites occurring at the time of place ment in seclusion or when putting on instruments of physical restraint 162. The low level of seriousness of these injuries was confirmed by the medical officer at the time of the inspection. In another unit for difficult psychiatric patients, twenty-four industrial accidents were reported in 2011, of which eleven were linked to agitation among patients. In one specialised hospital, this number is between six and twenty-three from 2002 to 2007. A final approach, presumably the most reliable with regard to situations involving security problems, consists of listing the cases in which staff have had to call for reinforcements (nursing staff from the same or other units). In one institution that accommodates around 3,500 patients a year, the number of “reinforcement call forms” came to 231 in 2006, 285 in 2007 and 350 in 2008. These forms present the advantage of showing the distribution of the occurrence of events between day and night (between a quarter and a fifth of the forms were drawn up for nocturnal events), and according to the causes163: the majority of calls are either due to “agitation” on the part of patients or “connected to treatment”. As might be expected, calls for reinforcement more often involve persons hospitalised without their consent than freely hospitalised personns. However, above all, the forms make it possible to establish that the calls are relatively exclusive to a relatively limited number of patients: For 240 forms studied, the distribution is as follows: 162 163 The most serious consequences reported involve injuries to “the left shoulder” and the “dorsal vertebrae”. Although the categories distinguished in the forms in this regard are somewhat vague (mixing of causes and times). 69