repeated, units that only accommodate freely-hospitalised persons, a fact which constitutes a major cause for concern. The establishment of closed regimes rarely takes place solely at the request of psychiatrists and nurses. It is promoted by a whole current of opinion, which leads to its being thought of as inevitable. It is in no way accompanied by any concern for the development of activities within units. As the inspection reports have indeed highlighted, it encourages clandestine behaviours (in particular in terms of consumption of cigarettes, when smoking is no longer allowed outside). It treats patients like children. In view of these drawbacks, it is difficult to weigh up the advantages of the establishment of closed regimes. As indicated in the Contrôleur général’s report for 2011, analysis of the incidents listed by the Ministry of Health concerning four hundred cases of patients running away, shows that the number of escapes from closed units is equivalent to the number of runaways from open units. As for the opposite effect (limiting intrusions into treatment units), its usefulness has never been stressed by staff in the interviews conducted by the Contrôleur général. It is true that it is upheld that the establishment of closed regimes in units makes it possible to reduce recourse to seclusion as well as, it is said, physical restraint (where i t is used). This is very possible (use of physical restraint has probably decreased in the long-term), but in no way certain. As the Contrôleur général has repeatedly stated, in most institutions there is no means of traceability with regard to the use of these means; and this is all the more the case with regard to their use forty years ago. Therefore, it is futile to hope to establish any irrefutable proof in this respect. In any case, it would be appropriate for the administrations responsible to now begin a process of reflection, informed by data of this kind, with regard to the advisability or otherwise of the establishment of undifferentiated closed regimes in treatment units. The development of video surveillance constitutes a second means of security. However, whereas the vast majority of institutions resort to the establishment of closed regimes within units, they are much more divided with regard to the use of video surveillance. Some of them have made a clear choice not to use such systems. Others, on the contrary, have introduced them extensively: in one institution inspected, twenty-seven cameras had been installed, without their usefulness being immediately obvious; it was all the less so, moreover, in view of the fact that, of this number, eleven were no longer working. Many hospitals limit the use of surveillance to their external surroundings, in order to prevent both running away and intrusions. In one of them, sixteen cameras have been installed, whose monitors are deployed in the reception area and the adjacent security area. Just under half of them film the entrances (two public entrances, the staff entrance, the “deliveries” entrance, the ambulance bay, the bay for other vehicles); the others monitor sensitive areas (underground car parks, the delivery yard staircase, the fire escape etc.). The areas immediately surrounding some institutions are also protected, without any video surveillance system, by alarm systems linked to the security post. Here we will not repeat what can or cannot be expected from these systems, which has already been indicated in the annual report for 2009, as recalled in the part of this section concerning police custody166. Three considerations should be specified however. On the one hand, it would be desirable for the principle of these systems, which can be taken badly by patients, to be discussed among the staff. On the other hand, it should be repeated here 167 that such systems can give rise to a false feeling of security: in one institution, which was the subject of a report in 2012, the installation of cameras in the seclusion rooms provided justification for staff no longer checking on the situation of patients thus secluded with their own eyes more than 166 167 Page 33 above. nd Cf. the conclusions of the inspection report for the institution of Eygurande (Corrèze), 2 July 2010. 71