Adeline Hazan, Controller General of Places of Deprivation of Liberty (CGLPL), denounces the increase in hospitalizations without consent and the trivialization of prohibitions in psychiatry. Interview.
Adeline Hazan, Controller General of Places of Deprivation of Liberty (CGLPL), has just published her report for the year 2017. Regarding psychiatry, she denounces an increase in hospitalizations without consent and a trivialization of restrictions, calling for an “awareness” of the rights of the hospitalized person. Interview.
Why Doctor. In your report, you denounce the excessive use of hospitalization without consent. What is the finding?
Adeline Hazan. In many establishments, 40%, sometimes 50%, of hospitalizations are without consent. According to national statistics, hospitalizations without consent have almost doubled over ten years! This is a real problem.
What are the causes of this increase?
AH. They are a bit difficult to identify. There is disinsertion: more and more people find themselves homeless or on the public highway, and are hospitalized without their consent. Since their creation in 2011, hospitalizations for imminent danger exploded. For the medical profession, in an emergency, this avoids seeking the authorization of a third party. The lack of resources for local psychiatry is another factor: the medico-psychological centers (CMP) are overwhelmed and some have been suppressed. As patients are not treated upstream, they are often in crisis when they arrive at the hospital.
Do you see any encouraging signs on prevention in mental health?
AH. No. Hospital medicine is in crisis. It is very difficult to find psychiatrists to officiate in hospitals and CMPs. As long as this recruitment crisis is not taken into account by the public authorities, this situation is likely to persist. Psychiatry is truly considered to be the poor relation of hospital medicine. I haven’t seen an ad that allows me to be optimistic on the subject.
You alerted in 2016 to the exaggerated use of restraint and seclusion. Have you been heard?
AH. Not enough. We had alerted two years ago about the CH of Bourg-en-Bresse where we had discovered unacceptable restraint practices. Our recommendations seclusion and restraint report were included in the 2016 Health Act: as short as possible, as a last resort, by decision of a doctor, with entry in a register. The law is therefore quite satisfactory. But it took fifteen more months to get a circular and despite that, some establishments have not yet done what is necessary. This slowness is a little worrying.
As at the CH Saint-Étienne, where you have denounced the “inhuman treatment” of some psychiatric patients.
AH. Fortunately, this situation is not representative, but what we have seen in Saint-Étienne is particularly serious. What is very worrying is that the HAS (High health authority, editor’s note) had passed three or four months earlier and had spotted nothing. The quality of care had been certified. This could have gone on for years to come.
Have you observed a decrease in the use of seclusion and restraint?
AH. The registers are slowly starting to fall into place, but at this point we haven’t been able to see a general decrease. It is undoubtedly a little early, we would have to wait a year or two.
You also denounce the fact that in a psychiatric hospital, everyday life is often reduced to a series of prohibitions: going out, smoking, visiting …
AH. One can quite hear that for such or such patient, the withdrawal of the telephone, the prohibition to see the family for fifteen days, the putting in pajamas, etc., are necessary. What seems to us to be an infringement of fundamental rights is the systematic nature. We visited hospitals where all patients were not allowed to see their families or use their cellphones for an entire month.
We often reduce the problem of psychiatry to a question of means, but you also call for an “awareness”, to no longer consider the patient as “an object of care”.
AH. The lack of resources is obvious. Practitioners often explain to us that if they had an hour to lower the pressure during a moment of agitation in a patient, it would avoid isolation or physical restraint. But it is also a question of establishment culture. With equivalent staff and resources, there are services where you decide not to practice isolation and restraint, and others where it is regular. When the manager decides to do without it, alternative solutions are found.
Are mental health professionals sensitive to this issue?
AH. Yes, more and more. At the end of our visits, practitioners often tell us that our visit allowed them to re-examine their practices. This was the case in Saint-Étienne. Most shocking is that patients were sometimes accommodated in general emergencies, tied on a stretcher, while waiting for places. The director immediately put an end to these practices. It is therefore possible.
As long as the external pressure is sufficient.
AH. Exactly.
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