Annual Report 2012: Spain’s National Preventive Mechanism Photograph 52 The center’s school The institutionalization syndrome was detected in many of the residents More work should be done to rehabilitate residents The possibility of community reinsertion should be reassessed periodically 142 188. A stay in these centers can give rise to the so-called «institutionalization syndrome», consisting of a series of symptoms provoked by the institution itself which little by little become ingrained in the resident’s identity and subse­ quently are indistinguishable from a mental disorder and difficult to revert without a change of environment. Some of the characteristic symptoms of the disorder include a low capacity to make decisions, lack of initiative, difficulty to plan time, lack of creativity and regression of inductive logical thinking, inca­ pacity to deal with new situations, isolation and difficulties to relate to other persons. During the inspection visit, the experts detected the said symptoms in many of the residents. In order to rehabilitate patients an appropriate diagnosis is need­ ed, together with individualized treatment plans, a re-diagnosis by an external professional and the possibility of a progressive change of environment to units that enable them to assume some degree of autonomy and control over their own lives (supervised apartments, open door mini-residences, day centers, etc.). However, in the case of residents who have spent decades in a residential center this process is very difficult and can generate in the affected parties more an­ guish than benefits. 189. In some persons under the age of 60 one could sense their despair at being in an institution where they felt they could spend the rest of their lives, without any alternative options of care in an open setting. In consequence, the Toledo Provincial Council has been urged to regularly reassess the possibility of com­ munity reinsertion in an open setting for some of these persons, in particular the ones who do not have a geriatric profile. In this sense, in paragraph 57 of the 8th General Report the CPT highlights that patients whose mental state no longer requires committal to a care residence should not continue to live in one due to lack of appropriate care or accommodation in the community. THE OMBUDSMAN OF SPAIN