Patients Calls One single patient accounted for ninety-seven calls for reinforcements; on the other hand, fifty-seven patients each provoked a single call. In total, seventy-four patients required a procedure of this kind, a number which remains relatively low, without in any way playing down the obvious risk that situations of this kind can present for professionals. It should be added that, in the very great majority of institutions, staff say that they work in secure conditions, during the day in particular 164. Assessments are more qualified with regard to the night, since there are naturally fewer staff present. Moreover, these assessments may, above all, include fears concerning individual patients 165, in what is often an atmosphere of trust. 2.5.2.2 Practical Means of Security What are the means used in order to establish security conditions that are considered acceptable? The most important consists of the establishment of closed regimes in units, a minority of which are still open at the present time (which does not mean without supervision). It is probable that the establishment of closed regimes in units is not simply a reflection of security concerns. One nurse explained that it was made necessary by the need for sound relations between patients and staff, using the expression “medical care also means constraint”. However, notwithstanding this point of view, closed regimes are also based upon principles of security. It would be useful to have an assessment of the current situation in this regard: the Ministry concerned should supply a comparison of the situation prevailing forty years ago and today. It would probably show a marked increase in closed units, including, it should here be 164 This conviction is important: it reduces the risks of inappropriate recourse to such measures. In particular, patients who are sent to units for difficult psychiatric patients and who subsequently return. It should be noted that the incidents mentioned here are sometimes reported to the State Prosecutor’s Office but rarely give rise to criminal complaints. 165 70