In its 2025 annual report, lThe general controller of places of deprivation of liberty, denounces a glaring lack of staff, poor accommodation conditions for patients, attacks on their freedom and even too many coercive practices that fall outside the legal framework. in mental health facilities… She emphasizes the case of child and adolescent or minor psychiatry “are hospitalized in adult units in disregard of their fundamental rights”Sometimes “isolated or attached”.
Fueled by its 138 visits to establishments in 2025 and the 2942 letters sent to it (14.07% concern health establishments), the CGLPL endeavored to present its main findings for each place of deprivation of liberty controlled: 23 penitentiary establishments, 25 mental health establishments, 8 hospitals receiving people deprived of their liberty (secure rooms), 8 specially equipped hospital units (UHSA), 1 interregional secure hospital unit (UHSI), 4 administrative detention centers (CRA), 1 waiting area, 11 closed educational centers (CEF), 11 courts, 45 police custody premises and a forced removal procedure.
Violation of patients’ rights, lack of staff, little or no appropriate care, scarcity of therapeutic activities, lack of information… The table, which nevertheless points to a great heterogeneity of situations (since ” modern and well-equipped structures rub shoulders with dilapidated and unworthy areas“) is particularly dark. Update on the particular situation of mental health establishments.
Crisis in medical and paramedical demographics
In mental health establishments, the glaring lack of medical and paramedical personnel appears to be the main determinant of most of the difficulties observed, first notes the CGLPL: bed closures, on-call obligations not physically present, irregular decisions, scarcity of therapeutic activities and deterioration of patient support. This shortage of staff is the cause of numerous violations of patients’ rights, she denounces. In addition, patients who cannot be cared for at the right time in free care or even on an outpatient basis, arrive in crisis, under the regime of care without consent, for longer periods and with heavier care, which themselves contribute to worsening the saturation of services. The crisis thus feeds itself.
The real estate and patient accommodation conditions also present a strong heterogeneity: modern and well-equipped units rub shoulders with dilapidated and unworthy areas. There are still double rooms in many units. Patients do not always have the option of locking themselves in their room using a “comfort lock”allowing patients to isolate themselves without preventing the arrival of caregivers. However, this long-standing recommendation from the CGLPL is now part of the operating standards of psychiatry activity (decree of September 28, 2022). Often, the prospect, even distant and uncertain, of ambitious real estate projects is enough to paralyze the carrying out of more modest compliance work.
Hear (in the CGLPL podcast ) psychiatric patients, subjected to isolation and restraint, which sees them tied by five points, ankles, wrists, torso, most often without the possibility of calling for help, even to go to the toilet. Extract from the foreword of the General Controller of places of deprivation of liberty – 2025 annual report.
The poor quality of patient information frequently vitiates procedures, she emphasizes. Notification of patients’ rights is poorly carried out, copies of the decisions which concern them are not given to them, psychiatry reception booklets are missing or unsuitable. Often made by untrained caregivers, notifications are not accompanied by any explanation. Some establishments have trained agents at the entrance office or have set up referents “rights” to improve patient information.
Numerous abusive restrictions on freedoms
The freedom to come and go and the various freedoms of everyday life are often limited. We thus observe the requirement, even for patients in independent care, of systematic permission to leave a department or hospital. We encounter restrictions on access to tobacco, the systematic removal of certain objects whose list varies from one establishment to another, or even from one service to another, the ban on certain means of communication, and the compulsory wearing of pajamas. All of this is just small things, but their accumulation has a tangible impact on a dignified life for patients and on the therapeutic alliance. The CGLPL recalls that the simple fact of caring for a psychiatric patient cannot justify any general restrictions apart from organizational rules necessary for all community life (prohibitions of common law, modesty, silence, hygiene, etc.) and those which make it possible to organize collective functioning (schedule of activities, use of premises, etc.). Any restriction must be individualized, motivated and traced and it can only last as long as the patient’s clinical condition justifies it.
Isolation and restraint practices, which are very heterogeneous, almost in all cases present notable deviations from the legal framework which authorizes and limits them. Initial decisions about placement in isolation or restraint are sometimes made by interns or associated doctors who are not authorized to decide. It is not uncommon for certain patients’ files to contain orders for seclusion or restraint “if necessary” which, in effect, delegate the psychiatrist’s decision to the healthcare team.
The existence of calming salons tends to become more widespread but is not yet systematic. Some of the spaces corresponding to this name are in reality just renamed isolation rooms. The isolation rooms themselves are often devoid of all or part of the expected equipment: no natural light or ventilation, no direct and free access to toilets, call buttons not accessible under restraint, no visible clock. Sometimes nursing supervision is supplemented by a video surveillance device which violates the patient’s privacy.
Walking in the corridor of a psychiatric care unit without consent, coming across patients tied up, waiting for a bed, on a chair or a stretcher, dressed in diapers. Everything is missing. There is a shortage of around 40% of hospital psychiatrists and caregivers. Ambulatory care, which would avoid hospitalizations, is also lacking. Extract from the foreword of the General Controller of places of deprivation of liberty – 2025 annual report.
37% of patients in care without consent placed in solitary confinement
The rates of use of isolation and restraint noted by the CGLPL are sometimes high. The national average for isolation is close to 37% of patients in care without consent. However, some establishments present much higher figures, close to 50%, sometimes coupled with extreme durations. Such figures once again demonstrate the weakness of policies to reduce the use of isolation and restraint. The CGLPL also highlights more encouraging examples. Thus, an establishment, with a proactive policy, reduced its isolation rate from 44 to 28% between 2023 and 2024.
Preparation for exit is organized in many structures but often comes up against insufficient downstream offerings. (specialized reception homes, nursing homes, accommodation establishments for dependent elderly people, rehabilitation structures) and very long administrative deadlines. Therefore, patients “long term” remain unnecessarily in hospital bedsincreasing overcrowding and reducing the capacity to accommodate new patients.
Minors: worrying isolation and restraint practices
Child and adolescent psychiatry systematically appears to be the most weakened link in the hospital system visited. The number of places in child psychiatry is insufficient and as a result minors are hospitalized in adult units in disregard of their fundamental rights. The lack of child psychiatrists is even more glaring than that of adult psychiatry practitioners. Isolation and restraint practices are concerning. No one seems to care that isolation, and even more so restraint, are always against the best interests of the child. and above all completely illegal concerning minors in independent care. However, awareness of this illegality is present everywhere and certain establishments go so far as to claim the absurd consequence that the illegality of the measure, without dissuading them from applying it, makes the judge incompetent to control it.
The complete annual report, published by Editions Lefebvre-Dalloz, will only be available in full on the CGLPL website from July 9, it can be cited in extracts from May 28 but not reproduced in full.
• 2025 activity report of the general controller of places of deprivation of liberty, May 28, 2026.
