The General Controller of places of deprivation of liberty (CGLPL) publishes the visit reports of eight specially equipped hospital units (UHSA), controlled in 2025 (out of the 9 in the French territory). This series of visits was an opportunity to address to the Ministers of Health and Justice general elements of analysis which point out, among other things, a very heterogeneous quality of medical and psychiatric care, a use of isolation and restraint often characterized by illegal practices, undignified conditions, excessive durations and a lack of traceability or analysis of the measures taken, as well as access to fundamental rights often hindered.
This series of visits to eight specially designed hospital units (UHSA) which accommodate detained persons suffering from mental disorders, was an opportunity to send to the Ministers of Health and Justice, alongside the visit reports, the following general elements of analysis:
The services visited suffer from a lack of qualified personnel, whether medical, nursing or prison. Therefore, reception capacities are not fully exploited, staff have to resort to degraded operating methods and experience unsatisfactory working conditions. It is also necessary to put in place training adapted to the mission of UHSAs, particularly with regard to patient rights or isolation and restraint measures.
Admission procedures are often incomplete or do not comply with patients’ rightsparticularly concerning information and the use of means of restraint during transfer or reception periods.
The premises, although generally maintained, often present architectural and functional defects that compromise patient privacy and comfort. In this regard, the possibility of protecting oneself from view, of closing one’s room when leaving it or of making confidential telephone calls must be guaranteed.
The quality of medical and psychiatric care is very heterogeneousmarked by gaps in the collection of consent, sought in an incomplete or irregular manner, by forced injections, breaches of medical confidentiality due to the presence of prison escorts during certain consultations, and difficulties with certain somatic care. Therapeutic activities, generally rich, are sometimes limited by a lack of resources or space.
The use of isolation and restraint is often characterized by illegal practices, undignified conditions, excessive durations and a lack of traceability or analysis of the measures taken. It thus happens that measures are taken by “non-psychiatrist professionals”, with the assistance of prison officers, or renewed without respecting legal deadlines. The recourse rate is very high, incompatible with the notion of last resort imposed by law. Least recourse policies are often formal, insufficiently ambitious or based on unreliable surveys. Isolation rooms do not always comply with current standards, practices of confinement in rooms, not traced and without a medical decision, are similar to illegal isolation and certain establishments do not have any calming space. Finally, caregivers must be trained in alternatives to isolation and restraint.
Access to fundamental rights is often hampered by administrative, logistical or organizational obstaclesimpacting social monitoring, preparation for discharge and maintaining links with the outside world. The role of the integration and probation services (SPIP) is insufficient or fragmented, limited to managing the files of people from the UHSA support penitentiary establishment. The production or renewal of residence permits or identity documents is often impossible, and access to a lawyer hampered by organizational or security constraints.
The law, coming from a period when it was hoped to establish UHSAs in sufficient numbers to meet the mental health care needs of all prisoners, expressly provides that they can accommodate minor patients. If some have given up on the grounds that they are not organized to do so in compliance with the rules which protect children, others do so on the grounds that without it, detained minors would be deprived of psychiatric care. However, in these cases, which are always rare, we observe that minors are not separated from adults, do not benefit from care from child psychiatrists or school education and are subject to isolation and restraint measures, which is contrary to their best interests. The intervention of the judicial protection of young people (PJJ) is finally very irregular.
The CGLPL points out that minors can only be accommodated in establishments where qualified child psychiatrists work, where compulsory education can be respected and where separation from adults is guaranteed. UHSAs are no exception to these rules, which means that as currently none are able to respect them, the necessary adaptations must be made. Failing this, the provision of the public health code which provides that “when their interest justifies it, detained minors may be hospitalized in a suitable department in an establishment (authorized to receive patients for care without consent) outside the units (specially equipped hospital units)” must be systematically used.
Although good practices and notable efforts are noted, they cannot mask the structural shortcomings due to the crisis facing psychiatry, aggravated in UHSAs by the inherent tension between safety imperatives and the ethical and legal requirements of health care.
See the report of the third visit to the UHSA of Lyon
See the report of the second visit to the UHSA of Marseille
See the report of the second visit to the UHSA of Nancy
See the report of the second visit to the UHSA of Orléans
See the report of the second visit to the UHSA of Rennes
See the report of the third visit to the UHSA of Seclin
See the report of the third visit to the UHSA of Toulouse
See the report of the third visit to the UHSA of Villejuif
The specially designed hospital units were established by the justice planning and orientation law of September 2002 (known as the Perben law). They complement the existing psychiatric care system within prison establishments with the regional medico-psychological services (SMPR). They accommodate detained persons of both sexes, minors and adults requiring hospitalization with or without their consent.
