- voluntary patients are placed in solitary confinement for periods exceeding 12 hours, without their hospitalisation status being updated. Several anomalies combined were found in one of the institutions visited: a high number of solitary confinement and restraint measures, with no regard for the recommendations of the Regional Health Agency, which may be maintained for several months, common restraint measures lasting for several days at a time or renewed, the systematic placement in solitary confinement and restraints of patients having made an attempt on their life, solitary confinement sectors with no visibility, call buttons and hardly any traceability. This particularly serious situation was referred to the Ministry for Solidarity and Health, whose response was expected on the date this report was being drafted. Article L 3222-5-1 of the Public Health Code, as it is set out by the Act of 26 January 2016 on modernising our health service, does not describe placement in solitary confinement and restraint as a "recommendation" but a "decision". This text also lays down the conditions for approving and renewing this decision: these must be "practices to be used as a last resort", which implies that measures aimed at avoiding them have been taken and recorded; their purpose must be to "prevent immediate or imminent harm to the patient or another person", which must therefore be spelled out; they must be taken "for a limited period", which must be specified; they must be subject to "strict surveillance", the arrangements for which must be organised and the implementation recorded; such surveillance must be "entrusted by the institution to health professionals designated for this purpose", the designation procedure and criteria for which must be defined and able to be checked. Where the measure is described as a "decision", it must be able to give rise to a use, the nature of which the law has not clarified. In connection with this use, it must naturally be possible for a judicial administrative authority to ensure that all of the conditions governing the use of solitary confinement and restraint, as stipulated by the law, are met. According to the information in the CGLPL's possession on the date this report was being written, no use of this nature has ever been performed. The CGLPL invites the public authorities and professionals concerned to give thought to this issue. 1.4 Institutions conduct policies driven by the desire to protect patients' freedoms and to set up more open care delivery models The desire to protect patients' freedoms first and foremost results from the balance that institutions choose between intra and extra-hospital services. Of course, it is not the CGLPL's place to inspect extra-hospital services which, by definition, do not deprive patients of their liberty, but it would be appropriate here to highlight the merit of such facilities both for a less traumatising care model than full-time hospitalisation and for the prevention of crises which lead to involuntary treatments - often in an emergency. In this regard, the CGLPL has met with several institutions whose strategic plans aim at reducing the proportion of full-time hospitalisations in their care provision by scaling up resources allocated to outpatient care and extending the opening times of medico-psychological centres. Often, this commitment logically comes hand in hand with a commitment to reducing the duration of involuntary care administered during full-time hospitalisation, so as to substitute care programmes for them. One of the institutions inspected was undergoing a reorganisation apparently in a bid to no longer accommodate voluntary patients on locked wards, which reduced their capacity. Along the same lines, this institution was also setting up a series of measures intended to personalise care provision and improve respect for patients' rights and freedoms. This initiative has taken the form of a "plan for users' rights", which aims at maximising freedoms whilst safeguarding security 19

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