Finally, as already pointed out 175, there is a discrepancy between the state of health of
patients in custody who are completely hospitalised, on the basis of the provisions of article
L.3214-1 of the code of public health 176, and the measures of constraint used with respect to
them. Moreover, for this reason, they usually keep their stay as short as possible, which harms the
effectiveness of the treatment given to them.
2.5.3.2 Relations between treatment units and departments
Once again, it should be cause for surprise that, with regard to the rights pertaining to patients,
the rules are so different from one unit to the next, with regard to the possession of mobile
phones for example. Institutions in which these rules have been standardised by agreement are
rare. The necessity of treatment in no way explains such discrepancies, which could be linked to
the state of a pathology but hardly to otherwise undifferentiated units.
In many institutions there are henceforth units responsible for dealing with psychiatric
emergencies. These should be encouraged, insofar as they are better equipped for carrying out
both assessments of the state of health of new arrivals and the procedures involved in the
implementation of treatment without consent, in particular as far as complete hospitalisation is
concerned. It has even been observed, during the inspection of one institution, that the creation
of an emergency psychiatric unit (in this instance in the general hospital of the administrative
centre of a French department) considerably reduces the use of ASPDRE and ASPDT, because
diagnoses of persons in distress, which are organised within a better framework, are better
established. The question remains however of the manner in which admission to emergency units
is related to the treatment then provided in traditional treatment units (in principle covering a
single sector), both from a therapeutic point of view and with regard to the completion of
procedures. In particular, should the length of stays in the unit, in principle relatively short,
coincide with the deadlines devised by the Act of 5 th July 2011?
The latter Act successfully instituted the obligation for all persons placed in complete
hospitalisation without their consent to undergo a somatic examination. The question of the
connection between psychiatric and somatic treatment is thus posed once again. The presence of
doctors working in somatic medicine in institutions and psychiatric units is very unequally
provided for, including in general hospitals which have both types of departments. The
requirements of the law of 2011 should be turned to good account in order to readjust this
presence where it is inadequate. It would be useful in this regard for the director general in charge
of provision of healthcare to distribute some kind of guide to good practice. It should be added
that when a single accident and emergency department is devoted to both somatic complaints
and mental pathologies, the persons suffering from the latter are in general poorly isolated from
other persons and confidentiality is little respected.
Finally, the presence of minors in psychiatric departments is often a sensitive issue. Even
when there are units devoted to child and adolescent psychiatry offering day services as well as
complete hospitalisation, the difficulties are not resolved for all that. In a general hospital whose
inspection gave rise to a report in 2012, the child psychiatry unit was installed within the
traditional paediatrics department. As a consequence, on the one hand, this unit operates a
selective admission process in order to avoid accepting any cases that are too serious, which
would prove impossible to handle in view of the rules applied within the department as a whole;
175
th
Assessment of 15 February 2011 of the Chief Inspector of places of deprivation of liberty concerning certain
th
procedures for hospitalisation by court order, Journal officiel of 20 March 2011, especially § 7.
176
The existence of the section of the public health code that details the conditions for complete hospitalisation of
prisoners without consent should have led to the abrogation of article D. 398 of the code of criminal procedure, which
deals with the same subject: this was not the case, and this regulatory text, which is different from the legislative text,
is still current.
76
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